Are you a new or returning student? *

New student

Returning student

Name *

First Name

Last Name

Date of birth *

MM

DD

YYYY

First parent's name

First Name

Last Name

Second parent's name

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone number *

(###)

###

####

Emergency number

(###)

###

####

Emergency contact

First Name

Last Name

Full time or part time student

Full time student

Part time student

Allergies - Do you have any allergies? *

Yes

No

Do you have any health related issues? If you select 'yes', please list below. If you selected no you do not need to list anything. *

Yes

No

I declare that all information filled out above is correct to the best of my knowledge. I commit to attending the First Nations Regional Adult Education Center for the full duration of the semester that I have applied for. *

I agree

I do not agree

I understand that I may be filmed or have my picture taken while attending First Nations Regional Adult Education Center. I am aware that my image may be used to promote FNRAEC to the general public. If I do not agree with having my image potentially being used for promotion, I will take the initiative to avoid being pictured or filmed. *

You may use my image taken at FNRAEC for promotional purposes

You may not use my image taken at FNRAEC for promotional purposes

Do you have your most recent transcripts? *

Yes, and I will email FNRAEC my current transcript

No, I do not have my current transcript but I give permission to FNRAEC to search for my current transcript