Student Information Verification
Student Legal Name: *
Student Preferred Name:
Student Date of Birth: *
MM
/
DD
/
YYYY
Indigenous ID:
Column 1
First Nation
Inuit
Metis
Native Student on Reserve
Native Student off Reserve
Clear selection
Student Home Address: *
Number/Street Unit/Apt# City Province Postal Code
Student Mailing Address (if different from Home Address):
Number/Street Unit/Apt# City Province Postal Code
Student Home Phone Number: *
Student Health Card Number:
Medical Alert Information/Disability/Allergies:
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