Academic Upgrading Intake Registration Form

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

* Indicates required field

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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