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Program Information

Program Name*

Past Education

Highest Prior Educational Experience*

Please List any current or prior post-secondary education, including DTI Programs

Program	Institute/School	Dates

Check all that apply

I have sent a copy of my unofficial transcripts to DTI
I have ordered my official high school transcript to be sent to DTI
I will request that my official high school transcript be sent to DTI

Please tell us, in your own words, why you are interested in this program*

Student Application Form

Please fill out all required fields and the privacy declaration at the end of this form. Upon completion and submission of your application, a confirmation email will be sent to the email you provided. If you have questions about the application form or program, please contact (306) 242-6070.

Are you currently attending DTI, or have you previously attended DTI?*

Personal Information

Last (Family) Name*

First (Given) Name*

Middle Name(s)

Preferred Name (if different from First Name)

Previous Name (if applicable)

Gender*

Gender: Dumont Technical Institute recognizes and welcomes the autonomy of individuals of all genders to be referred to in a way that reflects their identity. All applicants are welcome to signify the gender that they identify with.

Male
Female
I perfer not to identify

Date of Birth*

Social Insurance number*

Health Services Number*

Indigenous Ancestry & Affirmation

Please provide your Métis Nation Saskatchewan (MN-S) Citizenship number or check applicable box below.

Ancestry*

Registered Métis (MN-S) Citizenship Number

Contact Information

Physical Address (Street, Box or Apartment Number)*

Please fill out both physical and mailing addresses.

City/Town*

Province*

Postal Code*

Country*

Mailing Address (Street, Box or Apartment Number)*

City/Town*

Province*

Postal Code*

Country*

Home Phone (include area code)*

Cell Phone (include area code)

Business Phone (include area code)

Email Address*

Main activity in the Past 12 Months

Main Activity*

Are you currently receiving ?*

Employment Insurance
Social Assistance
None

Alternate/Emergency Contact

This person will be contacted if we cannot reach you by way of your contact information, or in the vase of an emergency.

First (Given) Name*

Last (Family) Name*

Mailing Address (Street, Box or Apartment Number)*

City/Town*

Province*

Postal Code*

Home Phone (include area code)*

Cell Phone (include area code)

How did you learn about the program?*

Declaration

The privacy of your information is important to us. Personal information that you provide to DTI may be shared with Gabriel Dumont Institute Training and Employment for the purpose of planning, education, and employment-related assistance. If you do not wish to share your information, please contact the Student Registration Department at 306-242-6070.

By selecting I Agree below, I acknowledge my consent to DTI’s use and disclosure of my personal information as outlined above. I hereby certify that all the information on this form is true and complete.

I Agree

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Comments

This field is for validation purposes and should be left unchanged.

Name of School	Location	Date(s) Attended	Grade/Course

Employer Name	Location	Date(s) Employed	Position

Name of School	Location	Date(s) Attended	Grade/Course

Employer Name	Location	Date(s) Employed	Position

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Personal Information

Permanent Address

Mailing Address

Please indicate if you are:

Name and Address of Next of Kin to Be Contacted in Case of Emergency:

Finances

Please indicate your first and second choice of centre locations

DOCUMENTS

Program Information

Past Education

Student Application Form

Personal Information

Indigenous Ancestry & Affirmation

Contact Information

Main activity in the Past 12 Months

Alternate/Emergency Contact

Declaration

Saskatchewan Urban Native Teacher Education Program (SUNTEP)

Personal Information

Permanent Address

Mailing Address

Next of Kin

Indigenous Ancestry & Affirmation

Employment History

Finances

Please indicate your first and second choice of centre locations

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