Home
Adult Ed Student Pre-Registration Form
ALCDSB
This form is only available for individuals who are not currently registered in a high school program.
Select a Program *
Get Your High School Diploma
English As A Second Language
Literacy & Basic Skills
Personal Support Worker
Have you previously attended Loyola?
Yes
No
Personal Information
OEN (if applicable)
Legal First Name *
Legal Middle Name
Legal Last Name *
Preferred First Name
Preferred Last Name
Previous First Name
Maiden Name
Gender *
Select
Male
Female
Undisclosed
Identify Another Way
Date of Birth *
Email *
Phone Number *
Alternate Number
Address *
City *
Province *
Postal Code *
Citizenship Information
Country of Birth *
Province of Birth
Citizenship
Citizenship Status *
Select
Permanent Resident
Canadian Citizen
Refugee Claimant
Approved Refugee
CUAET
Visitor
Other
Entered From
Date of Entry to Canada *
First Language *
Emergency Contact Information
Emergency Contact First Name
Emergency Contact Last Name
Emergency Contact Phone
Do you have any life threatening medical conditions or allergies?
Additional Information
Supporting Agency
Support Worker
Last School Board Attended
Select
Algonquin and Lakeshore Catholic DSB
Last School Attended
Select
Last School Year Attended
OR
Last School Name
Last School City
Parent/Guardian First Name
Parent/Guardian Last Name
Parent/Guardian Phone
Language Information
Have you had an official language assessment completed?
Yes
No
Date of Assessment
What is your current Canadian Language Benchmark?
Please enter "PFL", or a number from 1-12 for each Canadian Language Benchmark field.
Canadian Language Benchmark - Listening
Select
PFL
1
2
3
4
5
6
7
8
9
10
11
12
Canadian Language Benchmark - Speaking
Select
PFL
1
2
3
4
5
6
7
8
9
10
11
12
Canadian Language Benchmark - Writing
Select
PFL
1
2
3
4
5
6
7
8
9
10
11
12
Canadian Language Benchmark - Reading
Select
PFL
1
2
3
4
5
6
7
8
9
10
11
12
Language you wish to learn?
HARTs Reference #
Select A Site
Preferred Site *
Select
Picton
Kingston
Belleville
Trenton
Belleville ESL
Kingston ESL
Selected Site Location:
Additional Files (Optional)
Assessments / Certificates
Choose File
Identification
Choose File
Download Release Of Records PDF
Release of Records
Choose File
Download Gathering Information Document PDF
Submit
