APPLICATION FOR SPECIAL PROGRAMS

Please complete this form and submit.

Are you a Canadian Citizen or Permanent Resident?

This application is only intended for domestic applicants.

Are you either employed by a dealership or applying for Program 8681 (Volvo/Mack MAP 32 Truck & Coach Technician) or 8688 (A.T.S. MAP 32 Truck & Coach Technician)?

This Application is intended only for individuals who are either employed by a dealership or applying for Program 8681 or 8688.

PLEASE PROVIDE DEALERSHIP INFORMATION

Dealership Name

Dealer Phone Number

Street

City

Province

Postal Code

Country

TELL US ABOUT YOURSELF

Applicants must meet all admission requirements and meeting admission requirements does not guarantee admission to program of choice.

Ministry Client ID # and/or Ministry Training Agreement #

Centennial Student ID

OCOT # (Ontario College of Trades)

First Name

Middle Name

Last Name

Previous Last Name (if changed)

Birth Date

Gender

Cell Phone Number

Home Phone

Alternate Phone

I’ve provided at least one phone number for college to contact (Cell, Home, or Alternate)

Email Address

Confirm Email Address

Province

Street Address

City

Country

Postal Code

Text Messages from Centennial College

By signing up via text, you agree to receive recurring academic and admissions related text messages from Centennial College Alerts. Std msg & data rates may apply.

Do Not AllowAllow

Basis for Admission Consideration

Please enter OSSD Date (Year/Month)

SELECT YOUR ACADEMIC PROGRAM

Choice 1

Modified Apprenticeship (MAP) Program

Start Date (Year/Month)

Choice 2

Modified Apprenticeship (MAP) Program

Start Date (Year/Month)

Choice 3

Modified Apprenticeship (MAP) Program

Start Date (Year/Month)

Certification: I hereby declare that the information submitted on this application is true and complete. I understand that any false or incomplete information submitted in support of my application may invalidate my application. I have read the Freedom of Information and Protection of Individual Privacy Statement (see below). I authorize my secondary school and to Ministry of Education.

FREEDOM OF INFORMATION AND PROTECTION OF INDIVIDUAL PRIVACY STATEMENT

The information on this form is collected under the legal authority of the Ministry of Colleges and Universities Act, R.S.O. 1980, Chapter 272, S.5; R.R.O. 1980, Regulation 640. The information is used for administration and statistical purposes of the College and/or the Ministries and Agencies of the Government of Ontario and the Government of Canada. Any inquiries about this authorization may be directed to the Registrar, Centennial College.

I Agree