Client Registration

Name as listed on official documentation*
First Middle Last
Kanien'kéha Name
Preferred Name, abbreviated name or nickname
Preferred Pronouns
- He/Him/His
- She/Her/Hers
- They/Them/Theirs
- Ze/Hir/Hers
- No Pronoun
- No Preference
- Other
Date of Birth*
DD slash MM slash YYYY
Address*
Town*
Postal Code*
Social Insurance Number*
Please enter your 9-digit social insurance number with no spaces
Band Number*
Please enter your 10-digit Band Number with no spaces
Primary Phone Number*
Other Phone Number
Email*
Confirm Email*
Preferred method of contact*
- Phone
- Email
- Text
Do you have dependents? (children 18 years and under)*
- No
- Yes - please provide ages below
Dependent Ages*
Do you have a valid driver's license?*
- No
- Yes
Are you currently employed? (Please select all that apply)*
- Full-time
- Part-time
- Underemployed
- Self-employed
- Full-time student
- Part-time student
- No
Please provide your place of employment*
Do you have any other sources of income? (please select all that apply)*
- Social Assistance
- Employment Insurance
- Post-secondary funding
- Family allowance
- No source of income
- Other (please specify below)
Other source of income*
Have you collected Employment Insurance (EI) within the last 10 years?*
- No
- Yes
- Currently receiving Employment Insurance
Please indicate level of education attained so far (please select all that apply)
- High School Diploma
- Post-secondary Diploma: College and/or University (please specify below)
- Need to complete high school credits
- Vocational diploma (please specify below)
- Incomplete credits/program/etc.
- Other training or education (please specify below)
- Other (please specify below)
Post-secondary diploma*
Vocational diploma*
Other training or education*
Other*
What can we help you with at Tewatohnhi’saktha? (please select all that apply)
- I am seeking support with career counselling, resume, letter of intent, mock interview, etc
- I would like to attend a vocational program
- I would like to access support to complete my high school diploma/GDT
- I am seeking support for employment and job search
- I am seeking business support and/or business program information
- I would like to find out about Entrepreneurship Training
- Other (please specify below)
Help Reason*
Were you referred to Tewatohnhi'saktha by any of the following?
- Another organization (please specify below)
- An academic insitute (please specify below)
- Family member/friend/colleague/existing client (please specify below)
- Other (please specify below)
Referral*
Declaration*
- I hereby agree that any and all information provided herein to Tewatohnhi’saktha can be shared and discussed with MCK Client Based Services, the Kahnawà:ke Education Center, the First Nations Human Resource Development Commission of Quebec, the Human Resource Development Commission, Emploi Quebec, or any school I wish to attend, for the purpose of verification of information: determining program/funding eligibility, to aid in statistical analysis and program design. I hereby declare that all the information provided to Tewatohnhi’saktha is accurate and true to the best of knowledge. I am aware that providing false information may result in the suspension or loss of financial assistance, benefits, and/or service from Tewatohnhi’saktha.

Client Registration

Client Registration

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