SHSM Certifications

I would like to register for:*

* indicates required field.

Contact Information

Applicant's First Name* Applicant's Last Name* Home Phone* Mobile Phone Please identify your gender* Date of Birth* / /

Adult Contact Email (acceptance pkg to come by email)* Street Address* City* Province* Postal Code (e.g A1A 1A1)*

Grade (as of June):* School Phone:* Full Name of School Board:*

School Name:* School Address:* School City:* School Province:* School Postal Code (e.g A1A 1A1):*

Name of Teacher Making Recommendation:* Contact Phone For Teacher:*

School Name (if different): School Address (if different):

Where did you hear about us?: Have you attended an OELC course before? Which one and what year?: