Adult Program Registration Form

Columbia Basin Alliance for Literacy (CBAL) and College of the Rockies partner to offer free literacy programs. This form registers you as a participant in CBAL programs and as a registrant at the College.

*Program Name(s)

*Adult's First Name

*Adult's Last Name

Former Last Name (if applicable)

*Adult's Date of Birth - ex. 1956-06-21 (include dashes)

Have you registered as a College of the Rockies student before? If yes, please include your student number. If not skip to the next question.

*Address: House number and street name (or PO Box #)

*City or Town in BC (if not BC include province)

*Postal Code

Phone

*Email

*Gender

*Would you say you are

*Were you born in Canada? If no, please indicate the country of birth.

*Immigrant Status

Indigenous Status

*DECLARATION The College of the Rockies and CBAL comply with the Freedom of Information/Protection of Privacy legislation of the Province of British Columbia. Information collected on application forms is used in the normal course of College and CBAL operations in accordance with this legislation. Please read the following before choosing Yes or No:

I declare that the information contained in this application is to the best of my knowledge, complete and correct. I hereby agree to comply with the rules and regulations of the College and CBAL.