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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