Kenjgewin Teg

374 Hwy 551 / M'Chigeeng, Ontario / P0P 1G0

Application / Registration Form - 2018 / 2019

Program

Additional Qualifications

For Ontario College of Teachers (OCT) applicants applying to an Additional Qualifications (AQ) course, please provide your OCT Registration number.

Personal Information

Current Address & Contact Information

Cultural Affiliation


(10 digits)

Employment Status

Academic History

Other Training / Certification

Support Network / In Case of Emergency

List at least two (2) people who you consider to be your personal support network (i.e. immediate family member, teacher, employer, etc.) and/or can be contacted in an emergency situation.

Exceptionalities

Please Identify if you have a verified disability that prevents you from using standard instructional materials.

Transportation

Career Plan

Sponsorship / Tuition

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Photo / Video Release Consent

As a participant under one of the training programs/courses offered through Kenjgewin Teg, I give Kenjgewin Teg and its employees:

1. Permission to photograph, videotape, and/or interview me;

2. The perpetual and non-exclusive right and license to use my image, my name, and/or quote from me about contingent work produced by or on behalf of Kenjgewin Teg without payment of royalties to me; and

3. Consent under the Freedom of Information and Protection of Privacy Act to use and disclose my image, my name, and/or a quote from me about contingent work produced by or on behalf of Kenjgewin Teg.

I waive any right to inspect or approve the finished edition.

I release, and agree to hold harmless, Kenjgewin Teg, its employees, and representatives from all actions, claims and demands arising from the Kenjgewin Teg’s collection, use, and disclosure of my image, my name, a quote from me, or a description of my involvement in issues regarding contingent workers.

I am 18 years of age or over, have read this Release before checking below, and accept the terms and conditions.

Freedom of Information and Protection of Individual Privacy

The personal information on this application is collected under the legal authority of the Ministry of Colleges and Universities Act, R.S.O. 1990,c.M.19,s.5 and Regulation 770, R.R.O.1990,s.8. The information is used for the administration and statistical purposes of the College and/or the Ministries and Agencies of the Government of Ontario and the Government of Canada. If you have any questions regarding the collection and use of this personal information, please contact the Registrar of the College.

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Consent to Disclosure

Required