Academic Upgrading and Essential Skills Application Form

Step 1 of 4

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Program Information

Program Name*

Code (SIS-OCSM)*

Program Location*

Dates and Times*

Coordinating Office*

Fees*

Contact Information

Name

Legal First Name*

First

Legal Middle Name

Middle

Legal Last Name*

Last

Former Name

(Maiden Name, if applicable)

Preferred First Name

First

Permanent Mailing Address

Mailing Address*

Street Address

Town/City*

Province*

Postal Code*

Contact Information

Primary Phone Number*

Alternate Phone Number

Email*

Email Address* Re-enter Email Address*

Do You Live on a First Nation Reserve?*

Yes, I live on First Nation Reserve.

No, I do not live on a First Nation Reserve.

What is the name of the First Nation where you live?

Alternate Contact Information

Contact Name

Contact Relationship

Contact Primary Phone Number

Contact Alternate Phone Number

Personal Information

Gender*

Birthdate

Year*

Month*

Day*

Social Insurance Number (SIN)

Citizenship Status

What is your Canadian Citizenship status?*

Language Information

Is English your first language?*

Yes

If No, what is your first language?*

Education

High School Education

Name of High School*

Province/Country*

Highest Grade or Level Achieved

When did you last attend high school?

Year*

Month*

Other Education

Name of Institution

Province/Country

Language of Instruction

Highest Level or Credential Achieved

When did you last attend a post-secondary institution?

Year

Month

Self-Declaration

Do you self-identify as a person of Indigenous ancestry in Canada, such as First Nations, Métis or Inuit?

Yes

Prefer not to answer

If Yes, please indicate your status

What is your Band affiliation?

This field is hidden when viewing the form

Do you consider yourself a visible minority?

Yes

Prefer not to answer

Accessibility Accomodations and Learner Supports

Do you consider yourself a person with a disability?

Yes

Prefer not to answer

Do you think you have any learning difficulties that may require you to have additional assistance to be successful with your studies?

Yes

Prefer not to answer

Sponsoring Information

Will your participation in this program be sponsored or funded by an agency, Ministry, Band, or employer?*

Yes

Not Sure

If yes, which agency, Ministry, Band, or employer will be sponsoring or funding you?

Contact Name

Contact Phone Number

Program Awareness

How did you hear about this program or course?*

(Check all that apply)

College Website

Social Media

College Viewbook or Pamphlet

Radio or TV

Newspaper

Poster

Electronic Sign

Letter or Postcard

Career Fair or Tradeshow

School Presentation

Guidance Consellor or Teacher

Government or Non-Profit Agency

Employer or Co-Worker

Family or Friend

College Staff or Instructor

Other

Would you like to receive information about Carlton Trail College's programs and events via email?

Yes

Career Plan Writing Assessment

Students who apply to our Academic Upgrading and Essential Skills Programs are required to complete an Intake and Assessment. As part of this assessment, you must respond to the paragraph below *

Please tell us about your education and employment goals. Focus on how academic upgrading or essential skills development is an important part of this plan and what you will do once you have finished. Your paragraph will be assessed based on the strength of your career plan and the quality of writing.

About your education and employment goals

Authorization and Consents

The information on this online form is collected under the legal authority of The Regional Colleges Act 1998 and the Local Authority Freedom of Information and Protection of Privacy Act (LAFOIP). The information is used for administrative and statistical purposes by Carlton Trail College and/or Ministries and agencies of the Saskatchewan Government and the Government of Canada. If you have any questions about the collection or use of this information, please contact the Carlton Trail College Privacy Officer at 1.800.667.2623.

Carlton Trail College reserves the right to revise or cancel programs, courses, policies or procedures, and alter tuition, fees or other charges as deemed necessary, at any time.

Acceptanced*

By submitting this form, I hereby acknowledge, authorize and consent to the following: *

I understand that my application to this program is not complete until Carlton Trail College receives all necessary supporting documents.
If I am being sponsored or funded by an agency, Ministry, Band, or employer to participate in this program, I hereby give authorized personnel of Carlton Trail College permission to disclose any required personal or statistical information related to my funding, performance and/or attendance in this program to the agency, Ministry, Band or employer that is funding me.
I agree to abide by the rules and regulations of Carlton Trail College, including attendance policies and payment of fees.
I hereby certify that all of the information provided is true and complete. I understand that false information may result in the cancellation of my status as a registered student.

Signature

Name*

First

Date

Year*

Month*

Day*

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Please review your information before proceeding

Please review your information below before proceeding to the Confirm and Submit Button at the bottom of the page. Your application will not be complete until you have submitted all necessary supporting documents. You may print or save a copy of this form for your records by using the following buttons. If you have any questions, please call Carlton Trail College at 1.800.667.2623 or 306.835.4000

Print a Copy Save as PDF

Please select a Payment Method

How will you be paying?*

Payment

Applicant First Name

First

Applicant Last Name

Last

Program Name

Code (SIS-OCSM)

Program Location*

Coordinating Office*

Adult High School – Adult 12 and Adult 10 FEES

Price:

Fee Notes

Card Owner Information

First Name*

First

Last Name*

First

Phone Number*

Email Address*

Mailing Address*

Town/City*

Province*

Country*

Postal Code*

Credit Card Information

Payment Method*

American Express

Discover

MasterCard

Visa

Supported Credit Cards: American Express, Discover, MasterCard, Visa

Credit Card Number *

Expiration Date Month Year

CVV2 * Cardholder Name

Payment by e-transfer

For e-transfers, please send payment to:

Please include the PROGRAM NAME, PROGRAM LOCATION and CODE in the notes section of your e-transfer.

Your application is not complete until payment of fees has been received. If you have any questions, please call Carlton Trail College at 1.800.667.2623 or 306.682.2623

Payment by telephone with a credit card

For telephone payments with a credit card, please call 1.800.667.2623 or 306.682.2623

Your application is not complete until payment of fees has been received. If you have any questions, please call Carlton Trail College at 1.800.667.2623 or 306.682.2623

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Program Application

Adult High School – Adult 12 and Adult 10

Program Information

Contact Information

Name

Permanent Mailing Address

Contact Information

Alternate Contact Information

Personal Information

Birthdate

Citizenship Status

Language Information

Education

High School Education

When did you last attend high school?

Other Education

When did you last attend a post-secondary institution?

Self-Declaration

Accessibility Accomodations and Learner Supports

Sponsoring Information

Program Awareness

Career Plan Writing Assessment

Authorization and Consents

Signature

Date

Please review your information before proceeding

Please select a Payment Method

Payment

Card Owner Information

Credit Card Information

Payment by e-transfer

Payment by telephone with a credit card

Are you sure you want to remove Applicant 2 from your application?

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