Student Personal Data Sheet

STUDENT PERSONAL DATA SHEET

To Be Used to Determine a Student's Suitability for Acceptance in a Particular Training Program.

DATE *

STUDENT PERSONAL DATA SHEET

To Be Used to Determine a Student's Suitability for Acceptance in a Particular Training Program.

First Name *

Last Name *

Middle Name:

Address *

Apt. *

Province *

City *

Country:

Postal Code *

Telephone (Home) *

Email *

Birth Date *

PERSONAL BACKGROUND

# of Dependents:

# of Children:

#(Ages):

Course/Program Interested In *

Are you willing to start immediately?

Yes No

If yes, Preferred Start Date:

If no, Reason:

Daycare Arrangements Made? *

Yes No

Residence *

Own Home Renting Live with Family Other

Name of Spouse (if applicable):

EDUCATIONAL BACKGROUND

High School Grade Attained *

Did you graduate or are you about to graduate from High School? *

Yes No

When did you graduate or are you about to graduate from High School? *

Name and Location of School *

Favorite Subject:

Best Subject:

Least Favorite Subject:

Post-Secondary Education *

University Community College Other

Name and Location:

Course Taken:

Course Length:

Graduated? *

Yes No

When

EMPLOYMENT RECORD

Current Employer:

Work Hours:

Job Description:

Date of Employment:

Previous Employer:

Previous Job Description:

Start date of previous employment:

End date of previous employment:

If Homemaker, previous job or training:

HOW DID YOU FIND OUT ABOUT CANADIAN COLLEGE?

Source *

Ad in Newspaper Yellow Pages TV Ad EI Benefits/HRDC A Friend Told Me

If a friend told you, their name:

Do you know of anyone who plans to attend, is attending, or has graduated from this college? *

Yes No

If yes, their name:

STUDENT SELF-EVALUATION

Present occupation

Not Too Promising Filled with Opportunities A Dead End Unemployed

Training expectation

May help me win a promotion May enable me to start a new career May give me an extra income

Greatest rewards

High Income A sense of accomplishment Enjoying the job Being my own boss

Career barrier

Not knowing the right people Not having enough ambition Insufficient training Lack of confidence

Decision making

I can make them myself I procrastinate I need to consult with others

Best qualities

Hard working and dedicated Great ambition An open and inquiring mind

Concentration ability

Good Fair Poor

Learning style

Memorizing Reading and trying to understand for myself Having someone else teach me and answer my questions

Understanding ability

Above average Below average Average

Working alone

I can set up and follow my own schedule I need occasional reminders I need close supervision

Problem solving

I ask the opinion of qualified people I try to figure it out myself I try to forget about the problem and hope it resolves itself

Responsibility acceptance

I find it difficult to accept I enjoy accepting it I prefer sharing it

Finish things started?

Yes No Sometimes