Cooperative Education Registration Form 25/26

The Catholic District School Board of Eastern Ontario collects personal information under the authority of the Education Act and the Municipal Freedom of Information and Protection of Privacy Act (MFIPPA), for the purpose of the administration of educational programs and services within CDSBEO. All information is collected in compliance with legal and regulatory requirements. The information will be used for registration and academic planning purposes and may be disclosed to as required by law. We implement important measures to protect your information from unauthorized access, use, or disclosure. You have the right to access and correct your personal information held by us. For questions about this collection, please contact the CDSBEO Privacy Officer at [email protected],

Please complete the form below. Required fields marked with an asterisk *

Course Registering (check all that apply)*

Answer required for "Course Registering (check all that apply)"

CDSBEO Co-op Education Course- Adult/OYAP (18+ ONLY)

CDSBEO Co-op Course High School Student- SHSM/Credit

First Name*

Answer required for "First Name"

Last Name*

Answer required for "Last Name"

Date of Birth*

Answer required for "Date of Birth"

Gender*

Answer required for "Gender"

Male

Female

Prefer not to specify

O.E. N. (if known):

Answer required for "O.E. N. (if known):"

Email Address*

Answer required for "Email Address"

Parent email address (if under 18)

Answer required for "Parent email address (if under 18)"

Mobile Phone (no spaces or dashes)*

Number Required

Address

Street Address*

Answer required for "Street Address"

City*

Answer required for "City"

Postal Code*

Answer required for "Postal Code"

Township

Answer required for "Township"

First Language*

Answer required for "First Language"

English

French

Other

Country of Last Residence*

Answer required for "Country of Last Residence"

Canada

Other

If other, please specify.

Answer required for "If other, please specify."

Country of Birth*

Answer required for "Country of Birth"

Canada

Other

If other, please specify.

Answer required for "If other, please specify."

If born in Canada, Province/Territory of Birth

Answer required for "If born in Canada, Province/Territory of Birth"

User of Information and Image: Do you consent to being photographed or videotaped, and your name, image and/or school work used in media coverage of school related events or board publications, or on the school or board website or Facebook page? *

Answer required for "User of Information and Image: Do you consent to being photographed or videotaped, and your name, image and/or school work used in media coverage of school related events or board publications, or on the school or board website or Facebook page? "

I do consent.

I do not consent.

VOLUNTARY FIRST-NATION, MÉTIS, and INUIT SELF-IDENTIFICATION - All parents/guardians of Indigenous students, and students aged 18 years or older, have the right to voluntarily and confidentially self-identify. Through self-identification the Board is able to collect relevant information which helps to provide programs and strategies supporting the needs of First Nations, Métis and Inuit learners. This information is being gathered in accordance with section 29(2) of the Municipal Freedom of Information and Protection of Privacy Act.*

Answer required for "VOLUNTARY FIRST-NATION, MÉTIS, and INUIT SELF-IDENTIFICATION - All parents/guardians of Indigenous students, and students aged 18 years or older, have the right to voluntarily and confidentially self-identify. Through self-identification the Board is able to collect relevant information which helps to provide programs and strategies supporting the needs of First Nations, Métis and Inuit learners. This information is being gathered in accordance with section 29(2) of the Municipal Freedom of Information and Protection of Privacy Act."

First Nation

Metis

Inuit

None of the above

I do not wish to disclose.

Former High School (if your last school attended was CDSBEO eLearning School or the PSW program, please select St. James Catholic Education Centre) *

Answer required for "Former High School (if your last school attended was CDSBEO eLearning School or the PSW program, please select St. James Catholic Education Centre) "

If the last school attended was not a CDSBEO school, what is the name of the last high school you attended?

Answer required for "If the last school attended was not a CDSBEO school, what is the name of the last high school you attended? "

What town/city is this high school located?

Answer required for "What town/city is this high school located?"

If you did not attend a CDSBEO high school, please email the following to [email protected]:

1) A copy of your Canadian Birth certificate or Immigrant/Refugee status forms

2) A copy of your high school transcript

3) Proof of mailing address

If you have a copy of your high school transcript, please upload it here:

Answer required for "If you have a copy of your high school transcript, please upload it here:"

Choose a file or drag it here.

Identify the last grade you completed:*

Answer required for "Identify the last grade you completed:"

Have you obtained your Ontario Secondary School Diploma (OSSD)?*

Answer required for "Have you obtained your Ontario Secondary School Diploma (OSSD)?"

Yes

If you have obtained your OSSD, which school did you graduate from?

Answer required for "If you have obtained your OSSD, which school did you graduate from?"

If you have not obtained your OSSD, do you plan to earn your OSSD (graduate) at the end of this summer?

Answer required for "If you have not obtained your OSSD, do you plan to earn your OSSD (graduate) at the end of this summer?"

What value of co-op are you registering for?

Answer required for "What value of co-op are you registering for?"

1 credit

2 credit

3 credit

4 credit

What courses are you hoping to link the co-op to? (separate course codes with a comma- if unsure, leave blank)

Answer required for "What courses are you hoping to link the co-op to? (separate course codes with a comma- if unsure, leave blank)"

What is the location of your placement? (Can be location of employment)

Answer required for "What is the location of your placement? (Can be location of employment)"

Name of the main point of contact for the co-op placement?

Answer required for "Name of the main point of contact for the co-op placement? "

Phone number of the main point of contact for the co-op placement?

Answer required for "Phone number of the main point of contact for the co-op placement? "

Permission to register.*

Answer required for "Permission to register."

You are under 18 years of age and parent/guardian has given you permission to register.

You are over the age of 18.

Please fix the highlighted areas below before submitting.

Cooperative Education Registration Form 25/26