Dual-Credit Programs Registration Form
Fill out the form carefully for registration
Student Name
First Name
Middle Name
Last Name
Birth Date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2003
2002
2001
2000
1999
1998
Year
Gender
*
Please Select
Male
Female
N/A
Address
*
Street Address
Street Address Line 2
City
Province
Postal Code
Student E-mail
*
Cell Number
*
-
Area Code
Phone Number
Alberta Student Number
####-####-#
Select your program
*
Please Select
Administrative Professional
Health Care Aide
Educational Assistant
Current grade
10
11
12
Graduated
Your current school
St. Peter the Apostle
St. Teresa Outreach
Spruce Grove CHS
Stony Plain Memorial CHS
Onoway High
Other
English Language Arts Course
*
English 30-1
English 30-2
English 20-1
English 20-2
English 10-1
English 10-2
Select highest level completed.
English Mark
*
Enter mark for highest level completed.
Additional Comments
Submit Application
Clear Fields
Should be Empty: