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Education/Training Registration

This form will enable ACTLAP to determine your status as a potential Student and Participant and assist us in analyzing your Literacy needs. Any organization wishing to have their staff registered on ACTLAP Literacy Training must be correctly registered with the federal government.

Applications will be sent via email to ACTLAP.

Personnal Information

Company Name/Organization

First Name

Last Name

Phone Number

Fax Number

Email

Highest education level

Mailing Address

Are applying for yourself or for others?

no yes

If yes, list their names and ages:

Date of Birth

Enter range

YEP			Adult Program
14-16	17-18		19-25	26-50	51+over

Requested Information

Training Centre Interest

Training Session Interest

Morning (10:00 am - 1:00pm) Afternoon (2:00 pm - 5:00pm) Evening (6:00 pm - 9:00pm)

Description of your interest and what you will like to get out of the Training Program and activities

How did you hear about ACTLAP.

Are you interested in utilizing our training program for you, your staff, or your clients?

Yes No

Do you have a computer or are you interested in our program to receive a computer after the Training Program Complete?

Own Computer Interested in receiving computer

What would you use the computer for?

Do you have a preference for a particular computer?

Note: A registration fee of $50 per person is applied once a candidate is accepted to the program.