Summer School Dual Credit Application Form
(Summer 2021)

The Summer School Dual Credit courses for this year are being offered in-person through Conestoga College, with the exception of Cyberpsychology, which will be offered remotely. For additional information, visit the Continuing Education website: https://www.ugdsb.ca/continuing-education/credit-courses/summer-school/dualcredit-conestoga/

Please complete the form below and once completed, your home school will be notified of your application.
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Applicant Information:
Legal First Name *
Preferred First Name *
Last Name *
Date of Birth *
MM
/
DD
/
YYYY
What is your gender? *
Status in Canada: *
Are you a Specialized High Skills Major Student? *
Do you have a current Individualized Education Plan? (IEP) *
Do you require accommodations to be successful? *
If yes, please specify:
Have you previously taken a dual credit course?  (i.e. Conestoga, Humber or Georgian) *
Email Address *
(email that you will check regularly - NOT UGCLOUD email)
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.
Address Information:
Address *
e.g. 123 Maple Street
Unit #
(if applicable)
City *
Postal Code *
(N1L 0C2)
Parent/Guardian Information:
First Name *
Last Name *
Relationship to You: *
Phone Number: *
(555-555-5555)
Parent/Guardian Email: *
High School Information:
School *
Current Grade Attending *
OEN Number *
(9 digit number in the format of 999-999-999)
Program Choice: *
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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