Name & Personal Information:

First:	required
Middle:
Last:	required

Street/P.O. Box:
City:
Province:
Postal Code:
Telephone #:
Email Address:	required
Date of Birth: (dd/mm/yy)

Sex:	Male Female
Marital Status:	Married Single Other
Do you hold a valid drivers licence?	Yes No    Classification:
Date of licence issue (dd/mm/yy)	Licence #
Social Insurance Number

Enrollment Information:

I wish to start at Central Training Academy:

Month:   Year:

Program:  Commercial Driver - Class 01 -12 Weeks Commercial Driver - Class 01 -6 Weeks Tandem Truck - Class 03 -6 Weeks Heavy Equipment Operator Class 08 24 weeks Motor Coach Operator - Class 02 - 12 weeks Boom Truck Opertaor - 24 Weeks Truck & Transport Mechanic 42 Weeks

Education Information:

Highest school level completed:
Have you completed a vocational program?	Yes No
If yes,  please state program completed:
Did you attend University?	Yes No
If yes,  please state program completed:
Adult upgrading?	Yes No
If yes,  please state grade completed
Other Education?

Financial Information:

	I intend to apply for Provincial Government Student Aid
	I can only attend if I receive sponsorship
	I am prepared to pay my own expenses
	Paying tuition through Central Training Academy
	Other, describe below

I wish to receive a student loan application	Yes No
I wish to receive a medical form	Yes No
I wish to stay at residence	Yes No

Where did you first hear of Central Training Academy?
additional comments (if required)