First Name: Last Name:
Street Address:
City: Province:
Postal Code: Country:
Telephone Number: Western Email Address:
Language(s) You Speak:


Western Student Number: (9-digit number)
Intended Program of Study:  
(i.e. Honors Specialization in Computer, Minor in Computer Algebra)
Are you applying to the Academic Enrichment Opportunity (AEO) program at the Richard Ivey School of Buisness?
Career Aspiration:   (if known)
Residence in first-year:   (if known)


1. Are you interested in participating in an organized community service program?
2. What types of programming interests you the most? Please select two.

3. What kinds of services and support are you interested to learn about to assist your academic and personal success while at Western?
4. How many hours do you volunteer on average a week?