Student Information

Last Name *

First Name *

Middle Name * 🛈

Address 1 *

Address 2

City *

Province * 🛈

Postal Code *

Phone *

Email Address *

Email Address (re-enter) *

Member of Fond du Lac First Nation *

Yes

Marital Status *

Married

Separated

Divorced

Domestic Partners

Single Parent

Unmarried

Decline to Answer

Residence Status *

Canadian Citizen

US Citizen

Other (Please specify below) Other (Please specify below)

First Nation Registration Number *

Birth Date * +

College, Institute of Technology or Trade School (Current) * 🛈

Program *

Major (If Any or Applicable)

Year of Study * 🛈

3rd Year

4th Year

5th Year

6th Year

Full Time Student * 🛈

Yes

Part Time Student * 🛈

Yes (If Yes, please describe applied internship or applied field work experience below). Yes (If Yes, please describe applied internship or applied field work experience below).

Academic Records

College, Institute of Technology or Trade School (Previous Two Years) *

City *

Province * 🛈

I have attached a copy of my government issued photo identification. * 🛈

Yes

I have attached a copy of my current College, Institute of Technology or Trade School enrollment verification document(s), including proof of partial or full tuition payment. * 🛈

Yes

I have attached copies of my previous two academic years of College, Institute of Technology or Trade School transcripts. * 🛈

Yes

If there are any deficiencies in this application or other considerations that should be brought to the attention of the review panel, please describe below. * 🛈

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