Indigenous Ancestry Form

Required fields are marked with asterisks (*)

Voluntary, Confidential Self-Identification of
Indigenous Ancestry

Parents and guardians of students with First Nations, Métis and Inuit ancestry (Status, Non-Status) who are under 18 years of age or younger, or any student 18 years or older are encouraged to voluntarily self-identify their ancestry. Proof of ancestry is not a requirement.

If you have already self-identified, we ask you to complete the online self-identification form again or check with your school's secretary to ensure our records are up-to-date. (Please see DCDSB Policy #PO516)

This form is to be completed by parents/guardians or students 18 or over. Families who selfidentified previously do not need to complete this form.

Student Information

First Name

Surname

Date of Birth

Grade

Name of School

I am a student of Indigenous ancestry (Proof of ancestry is not required).

Yes

Do you identify in the following

First Nation

Métis

Inuit

Other

If you would like to learn more about this initiative, please contact James MacKinnon, Teaching and Learning Consultant at the Durham Catholic District School Board at 905-576-6150 ext. 22291

Parent/Guardian or student age 18 or older information

Name

Formbuilder

Voluntary, Confidential Self-Identification of Indigenous Ancestry

Student Information

Parent/Guardian or student age 18 or older information

Voluntary, Confidential Self-Identification of
Indigenous Ancestry