Upper Grand District School Board - Dual Credit Application Form
(FOR THE 2023-2024 SCHOOL YEAR)

Please complete the application form below. Once submitted, you will then receive an email containing a copy of the DC Consent Form that you will need to complete and sign electronically, or print and give to your Guidance department to send in. This will complete the registration process. Students will receive further correspondence regarding their programs via email to their provided personal email addresses.  Please be sure to check your emails regularly.
NOTE: All Conestoga programs, other than Masonry and Health Care, are currently full. 
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Applicant Information
First Name (Legal) *
First Name (Preferred)
Last Name *
Date of Birth *
MM
/
DD
/
YYYY
What is your gender? *
What are your preferred pronouns? 
Status in Canada *
Email Address *
(email that you will check regularly - NOT UGCLOUD email). NOTE: Please make every effort to enter accurately, as this is the method that the colleges and instructors will use to communicate important information.
Cell # *
(555-555-5555) NOTE: If you don't have access to a cell,  please include your home # or a parent's cell # if possible.
Does the student have a current Individualized Education Plan? (IEP) *
Does the student require accommodations to be successful? *
If yes, please specify:
Does the student fall into any of the following categories? (check all that apply) *
Required
By September 2023, will the student have already graduated from secondary school? (i.e. 30+ credits) *
Is the student a Specialized High Skills Major (SHSM) Student? *
Has the student ever taken a Dual Credit course(s) before? *
Does the student have any medical concerns to be aware of?  *
If yes, please specify:
Address Information
Address *
e.g. 123 Maple Street
Unit #
(if applicable)
City *
Postal Code *
(N1L 0C2)
Emergency Contact Information
Emergency Contact First Name *
Last Name *
Relationship to You *
Phone Number *
(555-555-5555)
High School Information
School *
Current Grade Attending: *
OEN Number *
(9 digit number in the format of 999-999-999)
Georgian College - SEMESTER 2 (2-credit package)
Clear selection
Sheridan College - SEMESTER 2 (1-credit) *Transportation may limited due to campus location and schedules
Clear selection
Humber College - SEMESTER 2 (1-credit; *Transportation may limited due to campus location)
Clear selection
Conestoga College - SEMESTER 2 (2-credit packages. All CAPP & OYAP applicants will be interviewed) REGISTRATION CLOSED
Clear selection
Re-engagement Program (2-credit option: Group Fitness Leadership, Positive Psychology, 17 days, Mon, Tue, Thu, Fri - tbc)
* Referral from Guidance required
Clear selection
Freedom of Information
This information is collected under the legal authority of the Education Act and Co-operative Education and Other Forms of Experiential Learning Policies and Procedures Document. Users of this information will be teachers, community employers and the relevant support staff. Inquiries should be directed to the School to Career Office,  500 Victoria Road North, Guelph, ON, N1E 6K2, 519-766-8524. A copy of this form will be retained for a minimum of 1 year following completion of the course.  
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