Academic Upgrading Intake Registration Form

If you are interested in Academic Upgrading, please fill and submit this form to begin the intake process.

Student Information

First Name

Middle Initial (if applicable)

Last Name

Preferred Name

Date of Birth

Gender

Mailing Address

Street Address

Apartment/Unit Number

City

Province

Postal Code

Contact Info

Primary phone number

Secondary Phone Number

E-mail Address

Campus

I am interested in the following (check all that apply):

Math

Communications

Biology

Chemistry

Physics

Computers

Self Management/ Self Direction

Any other questions or comments please write here:

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