Gitxsan Development Enrolment Form
Immediate Skills & Training Application for Admission
Email address *
Untitled Title
Contact & Demographic Information
Date:
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YYYY
Last Name: *
Your answer
First Name: *
Your answer
Middle Name: *
Your answer
Birth date: *
MM
/
DD
/
YYYY
Please indicate which training course you are interested in applying for: *
Your answer
Status Number: *
Your answer
Sex:
Address: *
Your answer
Home Phone #: *
Your answer
Cell Phone #:
Your answer
Are you living on reserve or off reserve: *
Community you're from: *
Your answer
Are you currently employed? *
What is your preferred method of contact (email, cellphone, Facebook Messenger, etc. - Please provide information. I.E. FB profile name if FB messenger; Cell #, etc.)? *
Your answer
Income (Please check all that apply):
Education Level
What is the highest level of education you have completed? *
Required
Have you had an education assessment?
In Case of Emergency
Emergency Contact Person (full name) & relationship to you (spouse, friend, sister, etc.): *
Your answer
Emergency Contact Persons Phone #(s): *
Your answer
Terms & Conditions Declaration
1.) The above information is complete and correct to the best of my knowledge.
2.) I agree to inform Gitxsan Development Corporation of any barriers to training so they can assist me in addressing them.
3.) I authorize Gitxsan Development Corporation to access my records of attendance with training provider.
4.) I am aware I may be disqualified from receiving benefits of future training should I voluntarily or involuntarily exit the course or not attend on a regular basis.
5.) I agree to return any materials bought or provided to me (I.E. textbooks, PPE gear, uniforms, boots, supplies, tools, etc.) for the training should I quit or not complete the training.
6.) I understand that it is my responsibility to make sure contact information is up to date and accurate.
7.) I agree the information, related to this initiative will be shared amongst participating Provincial Ministry's, Federal Departments, Public/Private training institutions, organizations identified as being a partner to the training initiative/application of the client.
8.) I will not hold Gitxsan Development Corporation responsible for any claims, losses, damages, costs and expenses related to any injury or death of a person, or loss or damage to property caused or alleged to be caused by this initiative and that all necessary liability and life insurance shall be maintained by me for the duration of this activity.
9.) I understand personal information from this application will be protected and used in compliance with the Freedom of Information and Protection of Privacy Act (1992). Information will be used to verify my identity and for the purpose of research and evaluation.
10.) If I am a successful applicant, I will be fill out the Intake Survey and Outtake Survey as these surveys will be used as an additional tool for evaluation of training programs for future funding opportunities.
I have read and agree to the above Terms & Conditions Declaration: *
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