Application

Name: Carlton Trail College
Price range: $

*Required Field

What Program Are You Applying For?

Program Name *

Code

Type of Program

Program Location

Coordinating Office

Academic Start Month and Year

Complete Legal Name

First Name *

Last Name *

Middle Name(s)

Former Names(s)

Permanent Mailing Address

P.O. Box # or Street Mailing Address *

Town/City *

Province *

Postal Code *

Primary Phone Number* xxx-xxx-xxxx *

Alternate Phone Number xxx-xxx-xxxx

Email Address *

Alternate Contact Information

This person will be contacted if we cannot reach you by way of your other contact information.

Contact Name

Contact Relationship

Contact Primary Phone Number xxx-xxx-xxxx

Contact Alternate Phone Number xxx-xxx-xxxx

Personal Information

Your personal information is required for identification and statistical purposes.

Gender *

Birthdate (Please select year, month, and date.) *

Social Insurance Number (SIN) - (Carlton Trail College collects your SIN for the purpose of issuing tax receipts.) *

Sask. Health Services Number

Citizenship & Residency

What is your citizenship status? *

Are you a Saskatchewan resident? * Yes No

English Proficiency

Is English your first language? * Yes No

Education

Please complete the section below. You may be asked to provide a copy of your official transcript.

High School - Name of School *

Highest Grade or Level Achieved *

Last Attended (Month/Year) or Presently Attending *

Other- Name of Institution

Highest Grade or Level Achieved

Last Attended (Month/Year)

Accessibility Accommodations & Learner Supports

Completing this section may allow you to access reasonable accommodations to assist you with your studies.

Do you consider yourself a person with a disability? (This includes physical, intellectual, mental, psychiatric, sensory or learning conditions.)

Considering your previous educational experience, do you think you have any learning difficulties that may require you to have additional assistance to be successful with your studies?

Aboriginal/Visible Minority

Completing this section is voluntary and is used for statistical and/or funding purposes.

Are you of Aboriginal ancestry?

If yes, please indicate your status.

What is your Band affiliation?

Are you a visible minority?

Program Awareness

How did you FIRST become aware of THIS program or course? *

Would you like to receive promotional information about Carlton Trail College's programs and events via email? Yes No

Career Plan Writing Assessment

Students who apply to our Basic Education Programs are required to complete an Intake and Assessment. As part of this assessment, please complete the paragraph below.

Please tell us about your education and employment goals, focusing on how completion of basic education is an important part of this plan and what you will do once you have completed basic education. Your paragraph will be assessed based on the strength of your career plan and the quality of writing. *

Authorization and Consents

The information on this 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 program and courses, revise policies and procedures and alter tuition, fees and other charges as deemed necessary without notice.

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

I grant permission for authorized personnel of Carlton Trail College to access my academic records in the Saskatchewan Ministry of Education's Student Data System for the purpose of determining appropriate course counselling. All ABE applicants will be assessed for Level 4 programming.

If I am being funded by a government agency or ministry, Band or employer to participate in this program, I hereby give authorized personnel of Carlton Trail College permission to disclose information about my performance and attendance.

I agree to abide by the rules and regulations of Carlton Trail College.

By submitting this application, 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.

Please Submit The Following:

*If you are not a Canadian citizen, your Immigration Documents.

*If you have received your education outside of Saskatchewan, your Official Transcripts.

*If you have had an English language assessment, your English Proficiency Documents.

Please submit the required documents to your nearest Carlton Trail College office or mail to:

Carlton Trail College

611-17th Street, PO Box 720

Humboldt, SK S0K 2A0

Note: Faxed or photocopies of your documents are not accepted. Original documents must be seen and verified by authorized Carlton Trail College personnel.

Name *

Date *

Please enter the text below *

First Name