Upper Grand District School Board - Dual Credit Application Form
(For the 2019/2020 school year)

Please complete the form below. Once you hit submit, you will need to print off the DC Consent Form (http://www.ugdsb.ca/dualcredit/wp-content/uploads/sites/94/2017/08/Consent-Form-All-CollegesFillableFinal-UGDSB.pdf) and have it signed by your parent/guardian (if under 18 yrs of age) and yourself and return it to your home school guidance office.

Note: Your Dual Credit application will only be complete once this online form has been completed, and your completed and signed consent form has been handed in to your guidance counselor.
Applicant Information
What is your gender? *
First Name *
Your answer
Last Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Status in Canada: *
Email Address *
(email that you will check regularly - NOT UGCLOUD email)
Your answer
Cell # *
(555-555-5555) NOTE: If you don't have access to a cell, please include your home # or a parent's cell # if possible.
Your answer
Are you a Specialized High Skills Major Student? *
Do you have a current Individualized Education Plan? (IEP) *
Do you require accommodations to be successful? *
If yes, please specify:
Your answer
Address Information
Address *
e.g. 123 Maple Street
Your answer
Unit #
(if applicable)
Your answer
City *
Your answer
Postal Code *
(N1L 0C2)
Your answer
Emergency Contact Information
First Name *
Your answer
Last Name *
Your answer
Relationship to You: *
Your answer
Phone Number: *
(555-555-5555)
Your answer
High School Information
School *
Current Grade Attending *
OEN Number *
(9 digit number in the format of 999-999-999)
Your answer
Select the Dual Credit Program that you wish to apply for:
Conestoga College Programs (Semester 2)
Georgian College Programs (Semester 1 and 2)
Humber College Programs (Semester 1 and 2)
Referral Programs (Semester 1 and 2)
Freedom of Information
This information is collected under the legal authority of the Education Act and Co-operative Education and Other Forms of Experiential Learning Policies and Procedures Document. Users of this information will be teachers, community employers and the relevant support staff. Inquiries should be directed to the School to Career Office, 500 Victoria Road North, Guelph, ON, N1E 6K2, 519-766-8524. A copy of this form will be retained for a minimum of 1 year following completion of the course.
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