Breadcrumb Home Indigenous Education Program Application Form Indigenous Education Program Application Form If you are unable to submit or access this form, click here to download and save a PDF version. Program Please indicate your intended program of study Indigenous Classroom Assistant Diploma Program (ICADP) Indigenous Teacher Education Program (ITEP) Teacher of Indigenous Language as a Second Language (TILSL) Personal Information First Name Surname (Last Name) Former Name (if applicable) Mailing Address City Province - Select -AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code Primary Phone Number Secondary Phone Number Email Date of Birth Marital Status Single / Divorced / Widowed Married / Separated If documents are in a different name please provide proof of name change. Are you an Indigenous person? Yes No Please specify First Nation Inuit Metis Other Enter other… Status in Canada Canadian Citizen Permanent Resident Student Visa Other Visa Enter other… First Language English French Other Enter other… Country of Citizenship Arrival Date in Canada Enrollment Have you previously enrolled at Nipissing University? Yes No Last Program Last Program - None -AnthropologyBiologyBusinessChild and Family StudiesClassical StudiesCommerceComputer ScienceCriminal JusticeData ScienceEconomicsEducation (Consecutive)English StudiesEnvironment and Physical GeographyEnvironmental Biology and TechnologyEnvironmental GeographyFine ArtsGender Equality and Social JusticeGeographyHistoryIndigenous StudiesLiberal ArtsLiberal ScienceMathematicsNursingPhilosophyPhysical and Health EducationPolitical SciencePsychologyReligions and CulturesSocial Welfare and Social DevelopmentSocial WorkSociologyMaster of Arts in HistoryMaster of Arts in Sociology - Applied Social ResearchMaster of EducationMasters of Environmental Science/StudiesMaster of Science in KinesiologyMaster of Science in MathematicsPhD in Education (Educational Sustainability)Other… Enter other… Nipissing Student ID/Number Last Semester Have you taken any courses at a post-secondary institution since your last registration at Nipissing University? Yes No What institution(s)? Last Secondary School Attended From To Name of School Grade Completed Diploma Received? Yes No All Post-Secondary Institution(s) Attended From To Institution Program Degree / Diploma From To Institution Program Degree / Diploma Employment or Activities When Not a Full-Time Student From To Employer or Nature of Activity Job Title / Description From To Employer or Nature of Activity Job Title / Description Acknowledgement I hereby certify that all statements are correct and complete including my declaration of citizenship and status in Canada. I understand that I may have to provide documentation at some future date to substantiate my claim and that misrepresentation of this data may result in the cancellation of my admission or registration status.
