Online Application

Full Time Studies Application

= Required Field

Personal Data

Please select the intake you are applying for?

Have you ever attended the Indigenous Media Institute?
YesNo

How did you hear about Indigenous Media Institute?

Salutation:
Mr.MissMrs.Ms

Family Name:

Given Name(s):

Preferred First Name:

Citizenship

Date Of Birth (MM DD YYYY):

Place Of Birth:

What was your main activity during the last year?

Education and Training

Resume may be sent in lieu of this section

Last secondary school attended or currently attending:

Name of School:

Location:

Diploma Obtained:

Post secondary institutions attended or currently attending
(most recent first)

Institution:

Location:

Degree/Certificate/Diploma:

Dates of Attendance:

Institution:

Location:

Degree/Certificate/Diploma:

Dates of Attendance:

Institution:

Location:

Degree/Certificate/Diploma:

Dates of Attendance:

Contact Information

Permanent Address:

City:

Province/State:

Country:

Postal Code:

Home Phone:
()-

Alternate Phone:
()-

E-Mail Address:

Emergency Contact:

Relationship:

Address:

Phone (day):
()-

Phone (evening):
()-

Experience

Please list all previous experience related to the program which you are applying (ie. photography, art, computer classes, design, graphics, music, etc):

Questions? Contact us at:

info@indigenousmediainstitute.org

Phone: 780.701.7398

Toll-Free: 1.877.429.4878

Fax: 780.429.4042

Toll-Free Fax: 1.877.429.4042