Application

Name: Carlton Trail College
Price range: $

*Required Field

What Program Are You Applying For?

If you are applying for more than one program, you will need to submit an additional application.

Program Name *

Code

Type of Program (if known)

Program Location

Coordinating Office

Academic Start Month and Year

Complete Legal Name

First Name *

Last Name *

Middle Name(s)

Former Names(s)

Permanent 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

Proof of English Proficiency is required for all applicants whose primary language is not English. If English is not your first language, you must submit your English Proficiency Documents to your nearest Carlton Trail College office.

Is English your first language? * Yes No

Education

Final acceptance cannot be considered until your official transcript(s) is/are received. This includes transcripts from high school, ABE-Adult 12, GED, and post-secondary institutions

If you are presently in high school, you must provide a preliminary statement of high school marks signed by a high school official to be considered for conditional acceptance.

If you have received your education in a country other than Canada, a Foreign Credential Assessment Fee will be charged to assess your transcripts.

To request an official copy of your Saskatchewan high school, ABE-Adult 12 or GED transcript(s) visit http://www.saskatchewan.ca/residents/education-and-learning/credits-degrees-and-transcripts.

For all other transcripts, contact the relevant educational institution.

High School Education - Name of School *

Highest Grade or Level Achieved *

Last Attended (Month/Year) or Presently Attending *

Post-Secondary Education - Name of Institution

Highest Level Achieved

Last Attended (Month/Year) or Presently Attending

Disability & Learning Difficulties

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.)

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 Status

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?

Activity in Previous 12 Months

What best describes your activity in the 12 months prior to this application?

Sponsoring Information

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

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

Contact Name

Contact Phone Number

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

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 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 understand that my application to this post-secondary program is not complete until Carlton Trail College receives my transcripts, and other necessary supporting documents.

I hereby give authorized personnel of Carlton Trail College permission to discuss my application to and progress within this program with the affiliated or brokering institution.

If I am being sponsored or funded by an agency, 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 within this program to the agency, Band or employer that is funding me.

I understand that if I have transcripts from another country, I will be assessed a Foreign Credential Assessment Fee.

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

Please Submit...

*If you are presently in high school at the time of this application, a Preliminary Statement of High School Marks which is signed and sealed by a school official. Conditional admission may be considered on the basis of your preliminary marks.

*An Official Transcript of your final high school, ABE-Adult 12 or GED marks. To request a copy of your Saskatchewan transcripts, visit http://www.saskatchewan.ca/residents/education-and-learning/credits-degrees-and-transcripts.

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

*If English is not your first language, your English Proficiency Documents.

Final acceptance will be considered upon the receipt of all required documents. Conditional acceptance may be considered upon the receipt of your preliminary marks.

For more information, call 1.800.667.2623. Please submit 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

Signature

Name *

Date (yyyy-mm-dd) *

Please enter the text below. *

First Name