Clone of Student Success Registration 2025

Student Success Registration 2026
Applicant information - The applicant is the adult submitting the application. One submission per household.
Applicant

First NameLast Name
What is your prefered pronoun ?
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Applicant Date of Birth

MonthDayYear
Date
Do you have a spouse or common Law Partner

Full name of spouse of common law partner

First NameLast Name
Email of spouse of common law partner
example@example.com

Student information
1st Child Information

First NameLast Name
What is the child's date of Birth ?
What Grade will the student be entering September 2026?
What gender does the student identify as?
Name of the School the student will be attending in September 2026
Do you have another child to register for this program?

2nd Child Information

First NameLast Name
What is the child's date of Birth ?
What gender does the student identify as?
What grade will the student be entering in September 2026?
Name of the School the student will be attending in September 2026
Do you have another child to register for this program ?

3rd Child Information

First NameLast Name
What is the child's date of Birth ?
What gender does the student identify as?
What grade will the student be entering in September 2026 ?
Name of the School the student will be attending in September 2026
Do you have another student to register for this program?

4th Child information

First NameLast Name
What is the child's date of Birth ?
What gender does the student identify as?
What grade will the student be entering in September 2026?
Name of the School the student will be attending in September 2026
Do you have another student to register for this program?

5th Child information

First NameLast Name
What is the child's date of Birth ?
What gender does the student identify as?
What grade will the student be entering in September 2026?
Name of the School the student will be attending in September 2026
Do you have another student to register for this program?

6th Child Information

First NameLast Name
What is the child's date of Birth ?
What gender does the student identify as?
What grade will the student be entering in September 2026?
Name of the School the student will be attending in September 2026
Do you have another student to register for this program?

If you have more than 6 children to register to the program, please contact the Resource and Referral team for additional support.

The Resource and Refferal team can be reached at RRO-RRL@eorc-creo.ca

Please provide the following documents: - A piece of photo ID for each person in the household. - Proof of Address - Proof of income

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Authorization and Signature
By signing this client authorization form, you agree that the Eastern Ottawa Resource Centre has permission to share the personal information contained in the client application form (for the Student Success Sharing Program or the Christmas Exchange Program) with the Mutual Aid Exchange, which in turn may share the information with other community organizations or sponsors in order to provide you with the assistance you have requested.
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