Indigenous Education Program Application Form

First Name

Surname (Last Name)

Former Name (if applicable)

City

Province

Postal Code

Primary Phone Number

Secondary Phone Number

Email

Date of Birth

Marital Status

Single / Divorced / Widowed

Married / Separated

If documents are in a different name please provide proof of name change.

Are you an Indigenous person?

Yes

No

Please specify

First Nation

Inuit

Metis

Other

Status in Canada

Canadian Citizen

Permanent Resident

Student Visa

Other Visa

First Language

English

French

Other

Country of Citizenship

Arrival Date in Canada