Humber College   Continuing Education Registration Form
PLEASE USE ONE APPLICATION FORM PER PERSON.
Please provide your Student ID Number, if you have been issued one

I am completing a certificate/diploma -
program # OR a single course
TITLE
Mr./Ms./
Other		 LEGAL SURNAME FORMER SURNAME
(if applicable)		 GIVEN NAMES DATE OF BIRTH
YY/MM/DD
PLEASE INDICATE YOUR CITIZENSHIP STATUS IN CANADA: CANADIAN CITIZEN NATIVE ANCESTRY PERMANENT RESIDENT/LANDED IMMIGRANT OTHER
STREET NO. & NAME, P.O. BOX, R.R. # APT. NO.
CITY/TOWN PROVINCE POSTAL CODE E-MAIL ADDRESS
HOME TELEPHONE BUSINESS TELEPHONE Students applying for Post-Diploma Nursing Courses MUST include their REGISTERED NURSING ONTARIO CERTIFICATE OF COMPETENCE NUMBER:
METHOD OF PAYMENT (check one):
CERTIFIED CHEQUE VISA MASTERCARD DEBIT CARD
(in person)		 MONEY ORDER
PLEASE: NO CASH OR UNCERTIFIED PERSONAL CHEQUES.
MAKE FEES PAYABLE TO HUMBER COLLEGE INSTITUTE OF TECHNOLOGY & ADVANCED LEARNING.
ACCOUNT NUMBER EXPIRY DATE EXACT CARDHOLDER NAME (AS ON CREDIT CARD)
I have read and have understood the registration and academic requirements. N.B. All course applicants must sign this document. If you are under the age of 19, your parent/guardian must also sign.

Students with disabilities may contact the office for Students With Disabilities at 416.675.6622 ext. 5180 for information and/or service



Signature & Date
 Full fees required at time of registration. MAKE FEES PAYABLE TO HUMBER COLLEGE INSTITUTE OF TECHNOLOGY & ADVANCED LEARNING. We regret that incomplete applications MUST be returned.

MAIL completed applications to:
Humber College Institute of Technology & Advanced Learning - North Campus
Customer Service and Registration Centre
Continuing Education
205 Humber College Blvd.
Toronto , Ontario, Canada M9W 5L7
Rev. 05/09
FOR OFFICE USE ONLY


AUTHORIZATION

You may use your browser's print function create a form to use to register by mail, fax or in person. Please see our Registration Information page for further details on how to register.

Return to the Continuing Education Calendar.