Name:
Address:
City
Postal Code
Home #
Cell #
Work #
Email: *
Have you ever been a previous student with Can-Weld?	Yes No
What type of welding course are you interested in?
Have you ever welded before?	Yes No
If yes, please state where and when:
Are you CURRENTLY receiving employment insurance or any other financial assistance?	Yes No
IN THE PAST 3 YEARS, have you received employment insurance or financial assistance?	Yes No
How did you hear about Can-Weld?	Job Fair Newspaper Family/Friend Aboriginal Band School Counselor Telephone Book Website Other
If other, please specify where: