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Commitment Plan
Commitment Plan
CityU International Student Quarantine Commitment Plan
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Step
1
of 2
Personal Information
Are you a new or returning student?
*
I am a new International student
I am a returning international student
Name
*
First
Last
Email
*
Preferred Phone Number
*
CityU Student ID #
*
Country of origin
*
Date of Birth
*
MM/DD/YY
Entry Visa/Study Permit issue date
*
MM/DD/YY
Arrival information
Anticipated Date of Arrival Into Canada
*
MM/DD/YY
Port of Entry in Canada
Arrival by (airline name and flight #)
*
Quarantine Plan
Quarantine Location
*
Homestay (provide address)
Rental (provide address)
Hotel/motel/airbnb (provide name and address)
Quarantine Location Address
*
Next
Confirmation
Please confirm that you have read, understood and aware of the following:
Quarantine requirements
*
I have read, understood and I am aware of the requirement to comply with the Government of Canada’s Quarantine Act, including being aware of the penalties for violation of the Quarantine Act.Maximum penalties include a fine of up to $750,000 and/or imprisonment for six months.
I agree to comply with the requirements laid out in the CityU Self-Isolation Program for International Students and follow the self-isolation guidelines set out by the Canadian Ministry of Public Health.
My Self-isolation accommodation is organized for the full 14-day duration of my quarantine.
I confirm that my self-isolation accommodation it is not set up in a group or communal setting or is not near vulnerable persons (Indigenous or Seniors)
During my 14 days of self isolation, I agree to connect with CityU staff for daily check ins at (604) 689 2489
I have completed and printed the CityU Quarantine CheckList along with my travel letter to present at the port of entry.
I have registered via the ArriveCAN app.
I confirm that I have the appropriate medical insurance, effective as of the date of my travel to Canada, which includes coverage for Covid-19 during the quarantine period and have submitted a copy of the coverage to CityU.
Commitment to this plan
*
By submitting this form, I confirm that I have read, understood and I am aware of the importance of the quarantine procedure upon arrival to Canada, and will follow all criteria provided in this document as well as all requirements provided by the Government of Canada, for a full 14 days.
I agree
Signature
Clear Signature
Date signed
MM/DD/YY
Comment
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