New Trades Application Form

Trades Application Form

______________________________

Program

Personal Information

First Name

Preferred Name

Middle Name

Last Name

Gender

Gender Describe

Birth Date

SIN (Use SIN Number above)

(9 digits)

Current Address & Contact Information

Street

Address 2

City

State/Province

Zip/Postcode

Mobile Number

Cultural Affiliation

First Nation Affiliation

"Other" FN Affiliation

F.N. Band Number

(10 digits)

Employment Status

Are you employed?

Yes No Not Selected

Employer

Academic History

Secondary School Graduate

Yes No Not Selected

Mature Student (19 years or older by first day of class and less than secondary school diploma)

Yes No Not Selected

Have you previously attended Kenjgewin Teg or one of our partnering Aboriginal Institutions?

Yes No Not Selected

1. Secondary School(s) Attended

2. Secondary School(s) Attended

3. Secondary School(s) Attended

H.S. Transcripts Upload

1. College or University Attended

2. College or University Attended

3. College or University Attended

College / University Transcripts Upload

Other Training / Certification

1. Name of Training/Certification

2. Name of Training/Certification

3. Name of 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.

1. Name

Relationship 1

Address 1

Telephone 1

2. Name

Relationship 2

Address 2

Telephone 2

Exceptionalities

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

Do you have any exceptionalities?

Yes No Not Selected

Disability

Yes No

Learning Difficulties

Yes No

If yes to any of the above, has testing been provided?

Yes No Not Selected

Accommodations Required:

Transportation

Do you have access to your own vehicle/transportation?

Yes No Not Selected

Will you require transportation?

Yes No Not Selected

Sponsorship / Tuition

1. Sponsor / Funding Source

1. Sponsor Contact Person

1. Sponsor's Phone

2. Sponsor / Funding Source

2. Sponsor Contact Person

2. Sponsor's Phone

______________________________

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.

I Accept Declaration

Yes No Not Selected

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.

______________________________

Consent to Disclosure

I hereby certify that all statements on this applications are correct and complete to the best of my knowledge. I understand that any false or incomplete information may invalidate my application. I have read the Freedom of Information and Privacy Protections statement below. I authorize my previous educational institutions and/or the Ministry of Education to release my academic information and school record to the above mentioned academic institution. I also authorize the release of this information to the Ministry of Training, Colleges and Universities. I authorize Kenjgewin Teg and/or their partners to disclose academic information as required to sponsoring agencies or other adult education providers.

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