Family Program Registration Form
Columbia Basin Alliance for Literacy (CBAL) and Selkirk College partner to offer free literacy programs. This form registers you as a participant in CBAL programs and as a registrant at the College. Note: This registration is for the adults only - please do not include children's information.
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Program Name(s)
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Adult's First Name
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Adult's Last Name
Former Last Name (if applicable)
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Adult's Date of Birth - ex. 1956-06-21 (include dashes)
Have you registered as a Selkirk student before? If yes, please include your student number. If not skip to the next question.
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Address: House number and street name (or PO Box #)
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City or Town in BC (if not BC include province)
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Postal Code
Phone
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Email
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Gender
Woman
Man
Non-Binary
Unknown
Decline
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Were you born in Canada? If no, please indicate the country of birth.
Yes
No
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Immigrant Status
Canadian Born
Permanent Resident
Refugee or Refugee Claimant
Canadian Citizen
International Student
Work Permit
Other Immigrant Status
Indigenous Status
Non-Indigenous
First Nations
Metis
Inuit
Status
Non-Status
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DECLARATION: Selkirk College 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.
Yes
No