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Registration Form

First Name

Last Name

Date of Birth

Email Address

Gender Gender Male Female

Phone Number

Cell/Alternate Phone

Street Address

City/Town

Province/Territory

Postal Code

Ancestry Ancestry Indigenous - status Indigenous - non status Inuit Metis Other

Emergency Contact

Relationship to you

Contact #

Medical Conditions or Physical Restrictions Medical Conditions or Physical Restrictions Yes No

Details

Education Education University Grad College/Tech School Grad High School Graduate Less than Grade 12

Financial Financial Personal RESP / REF Loan or Line of Credit Indigenous (ISET/TC/Band/Other) Metis (GDI/DTI) WCB Government Funding Program (if available) Other/Not Listed Unknown

Please Select Your Desired Program:

Select Desired Equipment (for 16 HOUR HEO PROGRAM only): Select Desired Equipment (for 16 HOUR HEO PROGRAM only): Excavator Dozer Grader Articulated Truck Loader (if available) Skid Steer (if available)

Choose from the following 2025 Intakes:

Referral Referral Newspaper Internet Family/Friend Former Graduate College Guide Website Employment/Training Service Other

Submission Submission ***I hereby wish to have my application processed.

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