Wheelchair and Seated Mobility Form
Sign in to Google to save your progress. Learn more
Email *
Personal Information
How did you hear about this course?
Clear selection
Title
Clear selection
Last Name
First Name
Address/Location
Correspondence Addresses: Your mailing and e-mail addresses will be used for correspondence from the University. The U of A uses electronic communications with its applicants and students in lieu of many paper-based processes. Currently this most often includes information by e-mail or via website. Your personal e-mail address will be used to communicate with you.
City
Province
Country
Home Phone
Mobile Phone
Street Number
Professional Background (check all that apply)
Career Status (check all that apply)
 I am currently employed by (check all that apply)
If you are an Occupational Therapist currently employed with AHS (or partner) do you work in
Clear selection
Name of Degree (if applicable)
I am interested in registering for: *
 Have you ever taken an online course in the past?
Clear selection
Have you ever taken any education in wheelchair and seated mobility in the past?
Clear selection
If yes, please specify
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This form was created inside of University of Alberta. Report Abuse
Google Forms