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Indigenous Community-Based Master of Education Program Registration Form

Indigenous Community-Based Master of Education Program Registration Form. Please fill out all required fields and the privacy declaration at the end of this form.

This registration form will be used for internal purposes only, to verify ancestry, and to begin your student file at the Gabriel Dumont Institute. This is only one step in the application process. You must also apply to the Faculty of Education at the University of Regina complete your application. These instructions are on our website at www.gdins.org/graduate.

Upon completion and submission of your registration form, a confirmation email will be sent to the email you provided. You will then be contacted by a program representative within 10 business days. For any questions about the form or program, please contact (877) 488-6888.

Registration 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 form or program, please contact (877) 488-6888.
Personal Information
Last (Family) Name*
First (Given) Name*
Middle Name(s)
Preferred Name (if different from First Name)
Social Insurance number*
Health Services Number*
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)
Date of Birth*

MM slash DD slash YYYY
Email Address*
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
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)
Declaration

The privacy of your information is important to us. Personal information that you provide to the Gabriel Dumont Institute 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 GDI’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
Name
This field is for validation purposes and should be left unchanged.

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Indigenous Community-Based Master of Education Program Registration Form

Registration Form

Personal Information

Indigenous Ancestry & Affirmation

Alternate/Emergency Contact

Declaration

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