CUSP Member Registration Form

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Identification Information:

This information helps us identify you as a Concordia Student.

First Name: *

Last Name: *

Please identify your gender: *

Female

Male

Other:

Student ID Number: *

Program of Study: *

Level of Study: *

Undergraduate

Graduate

Independent

Student status *

Full-time

Part-time

Other:

Type of Student: *

Resident of Quebec

Out of Province Student

International Student

Expected Date of Graduation: *

YYYY

How are your funding your education? *

Work full-time

Work part-time

Student loans

Help from your partner or family members.

Other:

What is your family situation?

I raise my child/children with my spouse.

I live with my child/children in Montreal, and my spouse lives out of the city or country.

I am a single parent.

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