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 * +

University (Current) * 🛈

Faculty *

Major (If Any or Applicable)

Year of Study * 🛈

2nd Year

3rd Year

4th Year

5th or 6th Year

Post-Graduate Studies

Full Time Student * 🛈

Yes

Academic Records

University (Previous Year) *

City *

Province * 🛈

GPA: For undergraduate students, please report previous qualifying academic year GPA. For post-graduate students, please report final qualifying undergraduate year GPA. Please note: if no letter or numerical grades were assigned in Winter 2020 in response to the COVID-19 pandemic and this semester has been included in your GPA calculation, GPA must be recalculated based on the final two qualifying semesters of graded coursework obtained in an undergraduate degree. * 🛈

Please list any awards or honors that you have received. 🛈

Please list any athletic, extracurricular, or community service activities you have participated in. 🛈

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

Yes

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

Yes

I have attached a copy of my previous academic year's University unofficial transcript. Please note for students who have attended more than one post-secondary institution: if your GPA was calculated using coursework not displayed on your previous year's unofficial transcript, please upload a second relevant transcript. * 🛈

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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