1. Are you medically fit to enrol in the program chosen?
2. Have you suffered from health condition/disease/illness/injury that will hinder in-class and practicum exposure?
3. Have you been diagnosed with high blood pressure, heart disease, diabetes, paralysis, any disease of the brain, renal disease, tumor, epilepsy, hepatitis (of any type), HIV/AIDS, or any disease/disorder not mentioned? (if yes, explain)
4. Have you suffered from mental or physical disabilities or defect?
5. For female, are you pregnant? (how many months)
The personal information requested on this form is collected under the authority of the Post-Secondary Learning Act and section 33(c) of Alberta's Freedom of Information and Privacy Act and will be used for the purpose of admission, registration, issuing income tax receipts, scholarships and awards, convocation sending educational information, and for College research and planning. Certain personal information will also be disclosed to Statistics Canada to comply with the Statistics Act; Alberta
Advanced Education to meet reporting requirements, Alberta Employment and Immigration for determining and monitoring
student eligibility for their services; work experience and practicum sites to set up appropriate placements; Students Association for the purposes of membership, fee collection, and contacting students; and to the Alumni Association for the purpose of membership and information sharing. For information about the collection and use of this information, contact the FOIP Administrator at 10215-108 Street NW, Edmonton, AB 5J 4L5 Tel. 780.427 7145.
