Adult Learning Centre Registration
Room 103B- 111 54th Street, Provincial Building Edson, AB
Course or program name:
*
Name
*
First Name
Middle Name
Last Name
How can we contact you? Phone Number / Email
*
Please enter a valid phone number we can contact you at..
Email
*
example@example.com
Year of Birth
*
Gender
*
Female
Male
Prefer not to disclose
Where do you live?
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Town of Edson
Rural / Yellowhead County
Will you travel more than 50 km to attend?
Yes
What is your Status in Canada
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Canadian Citizen
Permanent Resident
Temporary Foreign Worker / Refugee
First Nations / Metis
Highest Level of Education Completed
*
Grade 8 or lower
Grade 9 -12 but did not graduate High School
High School Graduate or High School Equivalency
Post Secondary courses
College or University Graduate
Attended School Outside of Canada
Do you have a job?
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Yes
No
Are you currently looking for a job?
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Yes
No
How did you learn about this program?
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social media
website www.edsonlearning.ca
poster
friend / family
employer / co-worker
referral from another agency / organization
If you were referred by another agency, please provide the name.
We offer a safe and non-judgemental space. Everyone is welcome. Please share iif any of the following will make it difficult for you to attend:
the registration fee
lack of transportation
lack of childcare
work schedule
access to devices / internet
self-esteem / confidence
personal challenges
What are your learning goals? Do you have a personal or work related goal that you would like to achieve at this time?
*
Do you have any other concerns or anything else you would like to share?
Disclosure
The information collected will help the Edson and District Community Learning Society to develop your learning plan. It is required for program reporting and is confidential. I agree to an exit interview/survey when I have completed my program. These interviews help the Learning Center maintain and apply for new course opportunities for students.
Signature
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