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Schulich School of Education
Indigenous Education Programs
Indigenous Education Program Application Form

Indigenous Education Program Application Form

Program

Please indicate your intended program of study

Indigenous Classroom Assistant Diploma Program (ICADP)

Indigenous Teacher Education Program (ITEP)

Teacher of Indigenous Language as a Second Language (TILSL)

Personal Information

First Name This field is required.

Surname (Last Name) This field is required.

Former Name (if applicable)

Mailing Address This field is required.

City This field is required.

Province This field is required.

Postal Code This field is required.

Primary Phone Number This field is required.

Secondary Phone Number

Email This field is required.

Date of Birth This field is required.

Marital Status

Single / Divorced / Widowed

Married / Separated

If documents are in a different name please provide proof of name change.

Are you an Indigenous person?

Yes

No

Please specify

First Nation

Inuit

Metis

Other

Enter other…

Status in Canada

Canadian Citizen

Permanent Resident

Student Visa

Other Visa

Enter other…

First Language

English

French

Other

Enter other…

Country of Citizenship This field is required.

Arrival Date in Canada

Enrollment

Have you previously enrolled at Nipissing University?

Yes

No

Nipissing Student ID/Number

Last Program

Last Semester

Have you taken any courses at a post-secondary institution since your last registration at Nipissing University?

Yes

No

What institution(s)?

Last Secondary School Attended

From This field is required.

To This field is required.

Name of School This field is required.

Grade Completed This field is required.

Diploma Received?

Yes

No

All Post-Secondary Institution(s) Attended

From

To

Institution

Program

Degree / Diploma

From

To

Institution

Program

Degree / Diploma

Employment or Activities When Not a Full-Time Student

From

To

Employer or Nature of Activity

Job Title / Description

From

To

Employer or Nature of Activity

Job Title / Description

Acknowledgement

I hereby certify that all statements are correct and complete including my declaration of citizenship and status in Canada. I understand that I may have to provide documentation at some future date to substantiate my claim and that misrepresentation of this data may result in the cancellation of my admission or registration status. This field is required.

Nipissing University sits on the territory of Nipissing First Nation, the territory of the Anishnabek, within lands protected by the Robinson Huron Treaty of 1850.
We are grateful to be able to live and learn on these lands with all our relations.

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