FREEDOM OF INFORMATION AND PROTECTION OF PRIVACY
Information collected and maintained as part of our student records is collected under the authority of the Colleges and Institutes Act. Northern Lights College gathers
and maintains information used for the purposes of admission, registration and other fundamental activities related to being a member of the Northern Lights College
community and attending a public post-secondary institution in the Province of British Columbia. Information you provide will also be used for non-administrative
research purposes. This research includes longitudinal research using anonymous linked records in the B.C. Educational Records Linkage File (Link File). The
personal records in the Link File are not identiable and are not used for administrative purposes. For further information please contact the Registrar’s Ofce.
COURSE
REGISTRATION
Condential
OFFICE OF THE REGISTRAR
11401–8th St., Dawson Creek, B.C. V1G 4G2
Ph 250-782-5251 • Fax 250-782-5233 • nlc.bc.ca
PLEASE PRINT
PHONE
Home phone
Work phone
Cell phone
CITIZENSHIP
Canadian Landed immigrant
Student visa Other
If not Canadian, please state citizenship:
I WISH TO DECLARE ABORIGINAL STATUS
(please check all that apply)
First Nations Inuit
Status Métis
Non-status
Other
BILLING STATUS
Feepayer
Out of country/International
Senior citizen (60 years or older)
Sponsored
Agency name
Address
Phone
Fax
LEGAL SURNAME
LEGAL FIRST NAME
LEGAL MIDDLE NAME(s)
E-MAIL ADDRESS
PERMANENT MAILING ADDRESS
Address
City __________________ Province _________ Postal Code ___________
LOCAL MAILING ADDRESS, IF DIFFERENT THAN ABOVE
Address
City __________________ Province Postal Code
EMERGENCY CONTACT (OPTIONAL)
Name Phone
The student shall become familiar with the academic and administrative regula-
tions in the current College calendar. Northern Lights College reserves the right
to make changes as necessary without notice or prejudice.
COURSE NAME/NUMBER/DATE
188a/10.11.10-j
PLEASE PRINT COPY TO SIGN
Signature – Student ___________________________________________________ Signature – College Ofcial ____________________________________________
Date _________________________________________________________________ Date ________________________________________________________________
CAmPUS Of STUdIES Please check one
Chetwynd Campus
Box 1180, 5132-50th St., Chetwynd, B.C. V0C 1J0 – ph 250-788-2248 • fax 250-788-9706
dawson Creek Campus
11401 - 8th St., Dawson Creek, B.C. V1G 4G2 – ph 250-782-5251 • fax 250-784-7563
Fort nelson Campus
Box 860, 5201 Simpson Trail, Fort Nelson, B.C. V0C 1R0 – ph 250-774-2741 • fax 250-774-2750
Fort st. John Campus
Box 1000, 9820 - 120th Ave., Fort St. John, B.C. V1J 6K1 – ph 250-785-6981 • fax 250-785-1294
tumbler ridge Campus
Box 180, 180 Southgate, Tumbler Ridge, B.C. V0C 2W0 – ph 250-242-5591 • fax 250-242-3109
Student Number Social Insurance Number Date of Birth
(IF APPLICABLE) YEAR MONTH DAY
Male
Female
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