Apply for Continuing Education Part-Time Programs

Personal Information

First Name *

Last Name *

Middle Name

Other Name(s) under which you were previously registered

Student Number (if available)

Date of Birth *

Status in Canada *

Contact Information

Address *

City *

Province *

Postal Code *

Phone Number *

Confederation College Email (if applicable)

Other Email (Yahoo, Hotmail, Gmail, etc.) *

Basis for Admission Consideration

Note: Forward transcripts and/or supporting documents to: fax (807) 473-3731, in person to the Admissions department, Room A122 Shuniah Building, Thunder Bay campus, or by email at [email protected]

Please select one *

Part-Time Program

Start Date *

Program Choice *

Disclaimer

I understand and agree that by submitting this form, it is the equivalent of my electronic signature and will be treated as if a signed form was submitted to Registrar's Office.

Electronic Signature *

Today's Date *