Post Secondary Online Registration

Welcome to the online registration form for the Matawa Post Secondary in Thunder Bay, Ontario. Please fill out the form below. If you require assistance, please call the Matawa Reception at (807) 768-3300.

Hours of Operation: Monday – Friday 8:30 AM – 4:30 PM

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MATAWA POST-SECONDARY PROGRAM 200 N. Lillie St, Thunder Bay, ON P7C 5Y2 / Phone: (807)768-3300 Fax: (807)768-3301

STUDENT INFORMATION (INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED)

*Name

10-digit Band Number (status card)

Gender

Male

Female

First Nation

Reserve Residence

OFF

Application Date

Resided in Canada for the last 12 months?

YES

Date of Birth:

Student #:

S.I.N.:

*Email

Permanent Address

Street/PO Box:

City:

Postal Code:

Home phone:

Address While At School

Street/PO Box:

City:

Postal Code:

Cell phone:

Emergency Contact Name:

*Phone Number

Check one:

Single

Single Parent

Married

Common-Law

Spouse Full Name:(if applicable)

Check one:

Employed

Unemployed

IF CLAIMING DEPENDANTS: provide copy of identification of all eligible children (under 18 in school)

Name

Date of birth

Name

Date of birth

Name

Date of birth

Name

Date of birth

EDUCATION PLAN

Choose One

Full Time

Part Time

Modular

Choose One

Fall/Winter (September to April)

Spring/Summer (May to August)

Winter Term (January to April)

Summer Term (July to August)

Choose One

COLLEGE: Certificate or Diploma

UNIVERSITY: Bachelor’s Degree

GRADUATE: Master’s Degree

DOCTORAL: Doctorate Degree

Program Course Name:

Institution:

Address/Location:

Duration of Program (# of years)

Current Year of Study (the year you are in)

Academic Period for this Application

Expected Date of Graduation

High School Graduate?

YES

Last year attended High School:

Grade:

Previous Post-Secondary Education or Training (if applicable)

Institute

Program

Dates Attended

Funded By

Completed

I declare that all of the above information is complete, true and accurate. I agree to inform Matawa Post-Secondary of any changes which may affect my eligibility for allowance. I also declare that I have read and understood all definitions, rules and guidelines of this Application.

Signature

Date

CONSENT TO REQUEST AND RELEASE INFORMATION

Surname

First Name

Middle Name

Student Number

Educational Institute

Date of Birth

Address

A. Modular Student

Please provide a letter from your employer stating what type of financial support they are providing to you while in attendance with your modular program (ie: travel, accommodations, meals, other.)

B. Consent to REQUEST information

I, provide my consent, as required, by Matawa Post- Secondary Policy to allow the Matawa Post-Secondary Program Coordinator to request copies of information from employers, institutions and other funding agencies. This consent is intended to allow the Matawa Post Seconda

YES

C. Consent to RELEASE information

I, provide consent as may be required, by the Matawa Post- Secondary Policy to allow the Matawa Post-Secondary Office to release information and provide copies of documentation to employers, institutions and other funding agencies. This consent is intended to allow the Matawa Post-Secondary Program to provide information so that my eligibility for assistance may be determined.

YES

D. SIGNATURES:

This signed consent is valid until __________________________, 20.

Signature

Date

Applies to common-law / married applicants:

I, _______ am the partner of _. I have read and understood this document and by this authorization I provide my consent, as may be required by the Matawa Post-Secondary Policy, to allow Matawa Post-Secondary staff to request and release information about myself to government agencies in order to determine my partner’s eligibility to receive Educational Assistance.

NAME OF PARTNER

NAME OF APPLICANT

Signature of Partner

Date

Should you require a copy of the MPS Policy, please contact the MPS Office

STUDENT RIGHTS

Each student has the right:

• To the privacy of information

• To be informed of Post-Secondary Student Support Program Policies and Procedures

• To be treated respectfully by MPS staff

• To discuss extenuating academic circumstances without fear of reprisal

• To have any post-secondary issues resolved in a fair, equitable, and timely manner

• To file a complaint or appeal without fear of reprisal

STUDENT RESPONSIBILITIES

It is the student’s responsibility:

• To be informed of MPS policies, changes, and procedures

• To comply with MPS policies and procedures

• To treat program staff, faculty staff and students with respect

• To provide program/course documentation on schedule throughout the academic year. This includes Semester Timetables, Mid-Term Marks, Final Grades and Transcripts.

• To complete all course work on schedule as assigned by the Post-Secondary Institution

• To attend all required classes and tutorials

• To arrive on time for class and remain for the duration of the lesson/tutorial

• To maintain a minimum 2.0 Grade Point Average (GPA)

• To contact the MPS Office and check in once every two weeks via phone, email, text, voicemail

• To consult with MPS staff prior to withdrawal from a course/program

• To keep MPS staff informed of any changes to: bank information, email address, mailing address, contact number

• To not enter the Matawa Education Department building under the influence of alcohol/illicit drugs

I, have read and understand my rights and responsibilities as a sponsored student with Matawa Post-Secondary.

YES

Student Signature______________________________________________ Date: _______________________

MPS Coordinator/Counselor/Staff Signature______________________________________________ Date: _______________________

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200 Lillie N, Thunder Bay ON P7C 5Y2

Admin: 8:30am - 4:30pm - School: 9:00am - 8:00pm - On Call: 8:00pm - 6:00am

Welcome to the online registration form for the Matawa Post Secondary in Thunder Bay, Ontario. Please fill out the form below. If you require assistance, please call the Matawa Reception at (807) 768-3300.

Hours of Operation: Monday – Friday 8:30 AM – 4:30 PM

MATAWA POST-SECONDARY PROGRAM 200 N. Lillie St, Thunder Bay, ON P7C 5Y2 / Phone: (807)768-3300 Fax: (807)768-3301

STUDENT INFORMATION (INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED)

Permanent Address

Address While At School

IF CLAIMING DEPENDANTS: provide copy of identification of all eligible children (under 18 in school)

EDUCATION PLAN

Previous Post-Secondary Education or Training (if applicable)

I declare that all of the above information is complete, true and accurate. I agree to inform Matawa Post-Secondary of any changes which may affect my eligibility for allowance. I also declare that I have read and understood all definitions, rules and guidelines of this Application.

CONSENT TO REQUEST AND RELEASE INFORMATION

A. Modular Student

Please provide a letter from your employer stating what type of financial support they are providing to you while in attendance with your modular program (ie: travel, accommodations, meals, other.)

B. Consent to REQUEST information

C. Consent to RELEASE information

D. SIGNATURES:

This signed consent is valid until __________________________, 20.

Applies to common-law / married applicants:

Should you require a copy of the MPS Policy, please contact the MPS Office

STUDENT RIGHTS

Each student has the right:

STUDENT RESPONSIBILITIES

It is the student’s responsibility:

Issued by: Education Dept. Issue Date: Nov. 29, 2012 Revision # 9 Date: Jan 13, 2020. EDUC PS FORM 304 Approved by: SN