Anishinabek Educational Institute SIS and LMS Portal.Powered By Classe365

Program Choice

Program^*

Campus^*

Personal Information

First Name^*

Last Name^*

Email^*

Primary Contact Number^*

Date of Birth^*

Gender^*

Social Insurance Number

This for tax purposes. The partner college will issue an official tax receipt for tuition.

Citizenship

Community Affiliation

Band Number

10 digits

Residential Address

Residential Address 1^*

Street Address

Residential Address 2

Unit #, Apt #, etc.

City/Town^*

Province^*

Postal Code^*

Mailing Address (If different from residential address)

Mailing Address 1

City/Town

Province

Postal Code

Emergency Contact

Contact Name

Relationship

Primary Contact Number

Health and Learning Concerns

Individual Education Plan^*

Upload IEP

If you have a copy of your IEP, you may upload it here

Learning Concerns^*

Do you have any learning concerns you would like us to know about?

Health Concerns^*

Do you have any health related concerns that you would like us to know about?

Previous Education Information

Secondary Education^*

Secondary School Name

Secondary School Transcript

You may choose to upload a copy of your transcript here. PLEASE NOTE: Any transcripts that are uploaded with an application will be considered as copies. We will still require the official transcript in the original sealed envelope.

Post-Secondary Institution 1

Program of Study

Did you finish the program?

Yes No

Post-Secondary Institution Transcript 1

You may choose to upload a copy of your transcript here. PLEASE NOTE: Any transcripts that are uploaded with an application will be considered as copies. We will still require the official transcript in the original sealed envelope.

Post-Secondary Institution 2

Program of Study

Did you finish the program?

Yes No

Post-Secondary Institution Transcript 2

You may choose to upload a copy of your transcript here. PLEASE NOTE: Any transcripts that are uploaded with an application will be considered as copies. We will still require the official transcript in the original sealed envelope.

Employment Information

Employment Status^*

Employer Name

Your Role

Tuition Payment Information

Please indicate how you plan to pay for your tuition.

Your Funding Source^*

If Other

If you selected Other as your funding source, please explain.

Education Counsellor Name^*

If you have an education counsellor, please include their name here. If you do not have one, you can write Not Applicable.

Education Counsellor Contact^*

If you have an education counsellor, please include their phone number. If you do not have one, you can write Not Applicable.

Support Network Information

Students are responsible for a full-time workload during the entire length of the program. AEI would like you to explore and identify your support network while enrolled in the program.

Identify your support network while at home and work:^*

What arrangements will you make with your employer while attending classes and field placements?^*

Identify any personal, family or work related difficulties that may interfere with your ability to complete the program:^*

How do you deal with stress?^*

Alternate Program of Choice

Are you interested in any other program(s)?

Please check all that apply.

Binoojiinyag Kinoomaadwin - Early Childhood Education First Nation Child Welfare Advocate Native Community Worker Personal Support Worker Practical Nursing Pre-Health Sciences Social Service Worker

How Did You Hear About AEI?

Please check all that apply.^*

Information Session APSIP Tour AEI Open House AEI Newsletter AEI Facebook Page AEI Website Anishinabek Nation Newspaper Friends/Family Other

If Other

If you selected Other, please explain.

Declaration

I declare the information provided on this application is true and complete. I understand that any false information submitted in support of my application may result in the rejection of my application. I understand that I am required to provide official transcripts in the ORIGINAL UNOPENED SEALED envelope to the attention of the Registrar Services Coordinator.

Declaration^*

I Accept

Date of Application^*

For more information, please contact:

Kayla Bomberry, Registrar Services Coordinator

kayla.bomberry@anishinabek.ca

705-497-9127 ext. 2309

2024-2025 Application

Program Choice

Personal Information

Residential Address

Mailing Address (If different from residential address)

Emergency Contact

Health and Learning Concerns

Previous Education Information

Employment Information

Tuition Payment Information

Support Network Information

Alternate Program of Choice

How Did You Hear About AEI?

Declaration

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