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Student Information - Registration form for Ajax

How did you hear about us:

Surname:

First Name:

Preferred Last Name:

Preferred First Name:

Middle Name:

Date of Birth:

Gender - Prefer to Specify:

OEN:

Address:

City:

Postal Code:

Current Phone #:

Email Address:

If not born in Canada, date of entry (MM/dd/yyyy):

If you are not a Canadian Citizen, you must provide proof of Canadian Resident Status, Landed Immigrant Status or Student Visa Status.

First Language Spoken:

Emergency Information

Emergency Contact Name:

Emergency Contact Number:

Relationship to Emergency Contact:

Health Card #:

Previous Education

If yes, what year did you graduate:

Graduating School:

If you have not obtained your high school diploma, what was the name of last high school you attended:

City of School:

Year:

I know the course(s) I need (please specify):

Is your schooling subsidized by Ontario Works or LEAP? If yes, please list contact person and their phone number:

Attach transcript or credit history:

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Attach Photo ID:

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Attach citizenship document if born outside Canada:

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Attach Language Assessment if you took ESL/LINC classes:

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If you are interested in one of our Employment Training Programs, please complete this next section.

Otherwise, skip to the bottom to review the Student Code of Conduct and press 'SUBMIT'.

Employment Training Programs

Teacher or Program Leader approval is required for Employment Training Programs. A representative from the school will be in touch with you about the interview.

Once you have been interviewed and accepted by a teacher, you must pay the full course fee (if applicable) to hold your seat in the class.

If admitted to the program, I understand that attendance and punctuality are mandatory for successful completion. Archbishop Anthony Meagher CCEC reserves the right to decline an application if a student is not able to meet the requirements.

Please review the Student Code of Conduct.

I acknowledge that I have read and understand these conditions:

YES