Foundational Learning Application Form

Please don't fill out this input box.

First Name*

Middle Name*if you don't have a middle name please type in n/a

Last Name*

Birthdate*mm/dd/yyyy

Current Age*

Gender*

Female

Male

Prefer not to answer

Health Care Number*

What province is your health care coverage from?*

Alberta

Saskatchewan

Are you a Canadian citizen?*

Yes

If you wish to declare you are an Indigenous person, please select one of the following:*

Status Indian/First Nations

Non-status/First Nations

Inuit

Métis

Do you need services offered to students with disabilities or medical needs?*

Yes

If you need those services, please describe or list in this space.

Address and contact information

House/street address*

Town/City/Municipality*

Province*

Alberta

Saskatchewan

Postal Code*

Mailing addressIf this is different than your physical address

Email address*

Best phone number to call*please include your complete 10 digit number including area code

Other phone number where you can be reached:

Program choice and educational history

How did you hear about the program. Please check all that apply

I plan to begin studies (month/year)?*

What is the last grade you completed?*

In what year did you complete that grade?*

What is the name of the last high school you attended?*

In what town/city/municipality is that school located?

What is the province where the school is located?*

If available, we will require a transcript of your high school marks. You may request a transcript through your
province's education department.

If you have attended any post-secondary college/university, please fill in the institution's name:

Where is this post-secondary school located? Please fill in the town/city and province.

If you attended a post-secondary school, what did you take and when?Please name the program and the college/university

If you earned a credential, please indicate what you received:

certificate

diploma

degree

Have you taken any other skills training? Please list what it was, where you took it and when.

Job History

Please list the job(s) you've had in the past 2 to 3 years.

Choose one of your jobs (the longest or the most recent), and answer the following questions.

What did you do at this job?*

How did you get the job? For example, you might say you answered an ad, you applied or a friend/relative referred you.*

What is an example of something you really like about the job?

What is something you didn't like about the job?

Attendance and Transportation

Attending individual classes and programs may require activities that take place off-campus. You are responsible for
ensuring that you have your own or alternative reliable transportation to and from the college as well as other designated off-campus locations.

Please confirm whether you have reliable transportation to and from the Lakeland College campuses as well as other designated off-campus locations.*

I have reliable transportation method to attend classes on and off campus

I do not have reliable transportation to attend classes on and off campus

Please select your reliable transportation (check all that apply)*

own vehicle

parents/relative

cab

walking

other

Your goals

What do you see yourself doing in the next year? How does training fit into your plans?*

What do you see yourself doing/working at in 5 years?*

How do you think this program will help you?*

How do you plan to succeed in this program?*

Is there something that might stop you from attending classes or completing the program?*

Yes

If you answered yes, please explain what might prevent you from completing the program. For example, scheduled surgery, family illness, pending court case, child care or transportation.*If you answered no, please put n/a in this space

3rd party disclosure
Please fill this out if you want a parent/spouse/authorized person to provide information or access information about you.

This authorization will remain in effect as long as you are an active student at Lakeland College. You may request changes by writing the registrar's office.

First and last name of the authorized person

What is this person's relationship to you?

Street/Box/RR Address

Town/City/Municipality

Province

Postal Code

Best phone number for your authorized person

Alternate phone number

Email address of authorized person

Please allow the person named to give or receive information about me.

Yes

Applicant Declaration
I certify that all the information supplied in this application is true and complete in all respects.

I understand misrepresentation, falsification of documents or withholding requested information are serious offences and will
result in the cancellation of my admission and registration at Lakeland College.

If admitted, I agree to abide by the existing or amended rules and regulations set by the Lakeland College Board of
Governors.

I agree to the applicant declaration*

Yes

Date completed (yyyy/mm/dd)*

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