Application Form - English as a Second Language

Continuing Education - English as a Second Language

1. Course information

Please Specify Your Course Selection:*

Indicate the semester for which you are applying:*

Indicate the year for which you are applying:*

I would be interested in taking this course online, if available.

Yes

No

2. Documents required: (In order for your application to be processed, all required documents must be submitted)

Valid Government Identification (Required for non-credit courses). Can be one of:
a. Passport
b. Drivers License
c. Health Card
Please include a photo/scan of both the front and back of your proof of identification

Proof of Identification Front:*

Proof of Identification Back:*

3. Personal Information

Family Name:*

First Name:*

Date of Birth:*

Gender:*

Male

Female

4. Permanent Address (PLEASE NOTE: It is YOUR responsibility to notify us of any changes)

Number:*

Street/Rural Route/P.O. Box:*

Apartment:

City/town:*

Province:*

Country:*

Postal Code (important):*

Telephone:*

Secondary Telephone:

Email:*

Certificate and Signature

I certify that the information provided is correct.
If I am a Québec resident I also authorize Emploi-Québec and the training establishment offering the above measure to exchange the personal information necessary for the realization and the follow-up of my participation for the subsidy.

Signature:

Date:

Don't fill this field!

Contact

Student Services

B106

819-778-2270 ext. 1320

sservices@cegep-heritage.qc.ca

Continuing Education - English as a Second Language

Student Services

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