Issue link: http://georgiancollege.uberflip.com/i/423911
Continuing Education & Part-time Studies Guide Winter/Spring 2015 continuingeducation@georgiancollege.ca 6 3 Winter 2014 I Spring 2014 I span class="baec5a81-e4d6-4674-97f3-e9220f0136c1" style="white-space: nowrap;"705.722.1511a title="Call: 705.722.1511" style="margin: 0px; border: currentColor; left: 0px; top: 0px; width: 16px; height: 16px; right: 0px; bottom: 0px; overflow: hidden; vertical-align: middle; float: none; display: inline; white-space: nowrap; position: static !important;" href="#"img title="Call: 705.722.1511" style="margin: 0px; border: currentColor; left: 0px; top: 0px; width: 16px; height: 16px; right: 0px; bottom: 0px; overflow: hidden; vertical-align: middle; float: none; display: inline; white-space: nowrap; position: static !important;" 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I georgiancollege.ca /con-ed Registration for Continuing Education Method of Payment (for office use only) Cash (do not send cash in the mail) Certified Cheque/Money Order MasterCard Visa American Express Credit Card # ________________________________________________________ Expiry Date ______________________ Cardholder Name (if different from student) ________________________________________________________________ PLEASE PRINT — INCOMPLETE OR INCORRECT INFORMATION WILL CAUSE DELAYS IN PROCESSING Have you registered at Georgian prior to this term? Yes No Ms Mr ______________________________________________________________________________________________________ Miss Mrs Last Name First Name Middle Name ______________________________________________________________________________________________________ Previous Name(s) (if applicable) Social Insurance Number Student # _________________________ Date of Birth ____________________ Email Address ___________________________________ (if you have been given one) (required) YYYY/MM/DD Current Mailing Address______________________________________________________________________________________________ Apt Street Address City ______________________________________________________________________________________________ Province Country Postal Code Daytime Telephone # Previously Used Mailing Address (if applicable) __________________________________________________________________________ Please check if you are attending on a student visa authorization (international student). COURSE NAME START DATE FEE COURSE CODE If you are applying for a credit course, you must provide proof of admission requirements. Please Note: payment in full is due at time of registration. FREEDOM OF INFORMATION AND PROTECTION OF PRIVACY ACT: The information on this form is collected under the legal authority of the Ministry of Colleges and Universities Act, R.S.O. 1980, Chapter 272, S.S.; R.R.O. 1980 Regulation 640. The information is used for administration and statistical purposes of the College and/or the Ministries and Agencies of the Government of Ontario and the Government of Canada. For further information, please contact the Office of the Registrar. Phone: span class="baec5a81-e4d6-4674-97f3-e9220f0136c1" style="white-space: nowrap;"705.722.1511a title="Call: 705.722.1511" style="margin: 0px; border: currentColor; left: 0px; top: 0px; width: 16px; height: 16px; right: 0px; bottom: 0px; overflow: hidden; vertical-align: middle; float: none; display: inline; white-space: nowrap; position: static !important;" href="#"img title="Call: 705.722.1511" style="margin: 0px; border: currentColor; left: 0px; top: 0px; width: 16px; height: 16px; right: 0px; bottom: 0px; overflow: hidden; vertical-align: middle; float: none; display: inline; white-space: nowrap; position: static !important;" 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Fax: span class="baec5a81-e4d6-4674-97f3-e9220f0136c1" style="white-space: nowrap;"705.722.5118a title="Call: 705.722.5118" style="margin: 0px; border: currentColor; left: 0px; top: 0px; width: 16px; height: 16px; right: 0px; bottom: 0px; overflow: hidden; vertical-align: middle; float: none; display: inline; white-space: nowrap; position: static !important;" href="#"img title="Call: 705.722.5118" style="margin: 0px; border: currentColor; left: 0px; top: 0px; width: 16px; height: 16px; right: 0px; bottom: 0px; overflow: hidden; vertical-align: middle; float: none; display: inline; white-space: nowrap; position: static !important;" 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For your campus information, go to: choosegeorgian.ca/continuing-education I certify that the above information is true and complete. I understand that any false or incomplete information submitted in support of my application may invalidate my application. I have read the Freedom of Information and Protection of Privacy Statement (see above). I authorize my secondary school and Ministry of Education to release my academic information and school record to the above-mentioned college. I also authorize the release of this information to my secondary school and to the Ministry of Training, Colleges and Universities. Please note that this form, once signed, will provide the academic authority to register students in the above courses and sections. ___________________________________________________________________________________________ ________________________________________________________ Signature of Applicant Date REGISTRATION fOR cONTINUING EDUcATION GeorgianCollege.ca/con-ed