New WORKSHOP & TRAINING APPLICATION

Program

First Name

Last Name

Street

Address 2

City

State/Province

Zip/Postcode

Email

Cell Phone

Home Phone

Name as it appears on SIN Card

SIN

(9 digits)

Birth Date

Gender

Do you have any health problems?

Yes No Not Selected

Please list any health conditions that we should be made aware of: (i.e. allergies, heart disease, diabetes, seizures, etc.)

Do you have a high school diploma?

Yes No Not Selected

If yes, from?

If not, what is the highest grade you have completed?

Name of High School

Do you have a College or University Degree or Diploma?

Yes No Not Selected

If yes, in what field?

If you have credits from a College or University, please list.

Have you taken any Training Courses?

Yes No Not Selected

If yes, what type?

Did you receive a certificate/ Diploma?

Yes No Not Selected

Enter the above code

Required

Iohahi:io Akwesasne Education & Training Institute