Continuing Education Program Application Form - Carlton Trail College

Program Application

Selected Program

Red Cross First Aid/CPR C/AED – Recertification

* indicates required fields

Step 1 of 4

25%

Program Information

Program Name*

Code (SIS-OCSM)*

Program Location*

Dates and Times*

Coordinating Office*

Fees*

Add Applicant Information

You can add multiple students to your application. Please note that the program fees will apply to each added applicant individually.

Applicant 1

Enter the information for the first applicant you want to register to this course.

Contact Information

Name

Legal First Name*

Legal Middle Name

Legal Last Name*

Former Name

(Maiden Name, if applicable)

Preferred First Name

Permanent Mailing Address

Mailing Address*

Town/City*

Province*

Postal Code*

Contact Information

Primary Phone Number*

Alternate Phone Number

Email Address*

Re-enter Email Address*

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)

Self-Declaration

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

Yes

No

Prefer not to answer

If Yes, please indicate your status

What is your Band affiliation?

Do you consider yourself a visible minority?

Yes

No

Prefer not to answer

Sponsoring Information

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

Yes

No

Not Sure

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

Contact Name

Contact Phone Number

+ Add another applicant

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

Email

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

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, 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: *

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 information about my performance and attendance within this program to the agency, 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.

Signature

Name*

First

Date

Year*

Month*

Day*

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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 Continue to Payment Button at the bottom of the page. Your application will not be complete until you have submitted your payment. 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

Please review your information below before proceeding to the Confirm and Continue to Payment Button at the bottom of the page. Your application will not be complete until you have submitted your payment. 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

Please review your information below before proceeding to the Confirm and Continue to Payment Button at the bottom of the page. Your application will not be complete until you have submitted your payment. 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

Please review your information below before proceeding to the Confirm and Continue to Payment Button at the bottom of the page. Your application will not be complete until you have submitted your payment. 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

Program Name

Code (SIS-OCSM)

Program Location

Coordinating Office*

Red Cross First Aid/CPR C/AED – Recertification Fees

Price:

Number of Applicants

TOTAL FEES

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

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

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

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 306.682.2623 OR 1.800.667.2623.

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

Payment by telephone with a credit card

For telephone payments with a credit card, please call 306.946.2094 OR 1.800.667.2623.

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

Payment by telephone with a credit card

For telephone payments with a credit card, please call 306.554.3767 OR 1.800.667.2623.

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

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

Yes, remove No, cancel

Are you sure you want to continue to the next step?

Your application is not complete until payment of fees has been received. Please ensure you have completed payment before continuing.

Yes, continue No, go back

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