Fillable Registration Form Personal Information (The Michener Institute of Education at UHN)

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Registration Form Personal Information (The Michener Institute of Education at UHN)

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TheinformationonthisformiscollectedundertheauthorityoftheMichenerInstituteofEducationatUHNandwillbeprotectedandusedincompliancewiththeOntarioFreedom
ofInformationandProtectionofPrivacyAct,R.S.O.1990,c.F.31.StudentinformationheldbytheMichenerInstituteofEducationatUHNmaybeusedforadministrativeand
statisticalpurposesoftheInstituteand/ortheministriesandagenciesoftheGovernmentofOntarioandtheGovernmentofCanada.
Registration Form
Co n t i n u i n g Ed u c a t i o n C o u r s e s
Personal Information
Title (Mr./Ms./Dr) first name
Surname
Previous Surname
Student ID D.O.B
Home Address
City PostalCode
Province Country
Company Name
Effective 2019, Canada Revenue Agency (CRA) requires all designated
educational institutions in Canada to file T2202 Tuition and Enrolment
Certificates forms with the CRA. Subsection 237(1) of the Income Tax Act requires
that you provide your SIN, upon request, to the preparer of the tax information
slip. In order to meet this federal requirement, you must submit your SIN below:
SIN
HOW DID YOU HEAR ABOUT US?
Michener website
Colleague/friend
Advertising
Hospital news
Poster or flyer
Continuing education Catalogue
Conference/Career fair (please specify)
Magazine (please specify)
External website (please specify)
Other (please specify)
Other (please specify)
Telephone Number Day Evening Cell
Please update my address in the student information database
yes_ no e-mail:
Course Information
Course Code Section Title Date course is offered Course Fee

 
PAYMENT METHOD
Visa
Mastercard
Purchase order
Certified Cheque or money order*
Cash/Debit

(please attach)
(in person only)
Credit Card number expiry Date
Cardholder’s signature
*We do not accept personal cheques. Please make certified cheques payable to The Michener Institute.
ForOfficeUseOnly: 

StatusAppointeeYesMicheneralumnusYesStaffOther:
TheinformationonthisformiscollectedundertheauthorityoftheMichenerInstituteofEducationatUHNandwillbeprotectedandusedincompliancewiththeOntarioFreedom
ofInformationandProtectionofPrivacyAct,R.S.O.1990,c.F.31.StudentinformationheldbytheMichenerInstituteofEducationatUHNmaybeusedforadministrativeand
statisticalpurposesoftheInstituteand/ortheministriesandagenciesoftheGovernmentofOntarioandtheGovernmentofCanada.
How to Use This Form
Use this form to register for any continuing
education course – live, by distance or online
Please do not use this form to apply to professional programs.
A separate form is available at www.michener.ca/admissions/directly_to_michener
Personal information
Please complete the personal information section using your home address as we will use this information
to mail your receipt and any course materials as well as to contact you in case of course changes or
cancellations.
Course information
Tell us which course(s) you’d like to take. Remember to include the entire course code, including the
section number, where applicable (the number after the dash, e.g. rs810-2). Sections are used when
courses are offered on different dates or to different customer groups.
Paym e n t m e t h o d
Total your course tuition and tell us how you wish to pay. We accept Visa & MasterCard, Certified Cheques
and money orders (payable to the Michener Institute), Purchase orders and Ce Credits. You may also pay by
Cash or Debit Card if you register in person during business hours.
Send it in!
We’ll gladly take your registration by fax, telephone, mail or in person during business hours
(Mon. – Fri. 0900 –1700h). Please note that we cannot reserve a space for you until we receive payment, and
courses are filled on a first-come, first-served basis.
Note: Space is limited and registrations are accepted on a first-come, first-served basis. Late registrations are not guaranteed
notification of course changes or cancellations. We reserve the right to make changes to program availability, schedules and
requirements. We reserve the right to correct any typographical or printing errors. We treat your personal information with respect and
do not rent, sell or trade mailing lists. We may contact you about your course registration and to keep you informed of other events at
The Michener Institute.
Call (416) 596-3177 or
Toll free 1-800-387-9066
Fax (416) 596-3180
Email regoffice@michener.ca
The Michener institute
222 St. Patrick St., Toronto, Ontario M5T 1V4
www.michener.ca/ce
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Registration Form Personal Information (The Michener Institute of Education at UHN)

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Completed 10 February 2021

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