Breadcrumb Home Student Supports Indigenous Initiatives Indigenous Student Success Indigenous Student Information Form Indigenous Student Information Form First Name Last Name Student ID Email Program - Select -About the LibraryAccessibility ServicesAccounts PayableAncient StudiesAnthropologyArchivesBachelor of Science in Nursing (BScN)Bachelor of Science in Nursing (BScN) CollaborativeBachelor of Science in Nursing (BScN) Scholar Practitioner Program (SPP)BiologyBiology and ChemistryBiology and Chemistry and GeographyCampus ToursChemistryChild and Family StudiesComputational PhysicsComputer ScienceData ScienceEAPTEconomicsEDIA AuditEducation - In ServiceEducation - PreserviceEducation, MEd/PHD ProgramEnglish StudiesEnvironmental ScienceEnvironmental Science/Studies, MESc/MESExtended LearningFine Arts and English StudiesFine Arts/Visual ArtsGender Equality and Social JusticeGeography and GeologyGiving TuesdayHealth and SafetyHistoryHistory and Indigenous StudiesHistory, MAHonorary Degree RecipientsIndigenous Education ProgramsIndigenous History MonthIndigenous StudiesInterlibrary LoanInternational Student RecruitmentKinesiology, MScLiaison LibrariansLiberal ArtsLiberal ScienceMaintenanceMaster of EducationMathematicsMathematics, MScMature / Transfer Student RecruitmentMental Health & WellbeingModern LanguagesNative EducationNSONUListensOnline and College Partnership ProgramOntario High School Student RecruitmentOrientationParking ServicesPhD in Education (Educational Sustainability)PhilosophyPhysical and Health EducationPolitical SciencePost-Graduate Student RecruitmentPracticum OfficePresident WamsleyProfessional Learning ServicesPsychologyPurchasingQuality AssuranceRegistered Practical Nurse (RPN) to BScN Blended ProgramRegistered Practical Nurse (RPN) to BScN Bridging ProgramReligions and CulturesSchool of BusinessSchool of Criminal JusticeSchulich School of EducationService DeskSexual Violence Prevention and EducationSocial and Cultural StudiesSocial Welfare and Social DevelopmentSocial WorkSociologySociology, MAStudent Intervention ServicesStudent RecruitmentSummer Indigenous Education Programs Address (local) Address (home/permanent) Telephone (local) Telephone (home/permanent) Have you completed the voluntary self-identification process on WebAdvisor? Yes No Since you have not completed the voluntary self-identification process on WebAdvisor, please visit www.nipissingu.ca/self-id for instructions and more information. Do you receive funding from your band or other agency? Yes No Name of First Nation/Agency Do you speak a Native language? Yes No Native Language (Cree, Ojibway, Algonquin, Mohawk, etc.) Dialect (Nipissing, Manitoulin, etc.) Where did you receive information about Nipissing University programs? Dewendizon or Wiidooktadwin Mentorship High School Visit Community Career Fair Other… Enter other… Please select any of the following topics you want/need more information about: Spelling, grammar and punctuation Preparing for exams Academic essay writing Microsoft Word and computer basics Time management Improving your study skills Note taking APA, MLA and/or Chicago Formatting Indigenous Leadership Initiative Would you like to be included on our mailing list? Yes No (You will receive email messages and monthly electronic newsletter notifications of upcoming events, job postings, awards, scholarships and bursaries) Are you interested in volunteering in the Office of Indigenous Initiatives and/or for events and activities? Yes No (Some activities include: Welcome Pow Wow, Cultural Programing, Peer Mentorship, Indigenous Week, and Social events) Consent The Office of Indigenous Initiatives staff are here to support you while you are a student at Nipissing University. We can assist you with your academic and personal needs. At times, we may refer you to other departments and services within Nipissing University such as Accessibility Services, Career Counselling, Personal Counselling, Academic Advising, etc. To make such referrals, we may need to discuss the matter with a staff person in our office – and sometimes with a staff person from another department – to ensure that your matter is dealt with efficiently. You may also wish to have us share information with another department. By signing this consent form, you agree that the Office of Indigenous Initiatives staff may discuss and refer your academic or personal matter with other appropriate Nipissing University staff or faculty. Grade reports and other information for sponsorship purposes are sometimes requested by Indigenous education administrators or other sponsoring agencies/organizations as a requirement to receive post-secondary financial assistance. Please sign this release form to authorize Indigenous Initiatives staff to provide such information. Please note that only information directly related to the matter at hand will be disclosed to the education administrator or sponsoring agency. I have read the above statement, and I agree that Indigenous Initiatives staff may release information about me to other Nipissing University staff and/or faculty as needed in order to provide me academic and/or personal assistance. Protection of Privacy The information on this form is collected under the authority of the Nipissing University Act, 1992. It is related directly to and needed by the University to support you in Indigenous Initiatives at Nipissing University. The information will be used by employees of the Office of Indigenous Initiatives, the Office of Student Development and Services, and other departments on a need to know basis. If you have any questions about the collection, use and disclosure of this information, please contact the Office of Indigenous Initiatives, Nipissing University, 100 College Drive, North Bay, ON P1B 8L7, (705) 474-3450, ext. 4509. Please confirm the following in order to proceed You must check this box to acknowledge you have read, understand and agree to the terms above
