Client Registration

Name*
First Middle Last
Kanien’heha
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
Marital Status*
- Single
- Married / Common Law
- Divorced
- Separated
Do you have a valid drivers’s license?
- Yes
- No
Are you currently employed?*
- Yes
- No
Do you have any other sources of income? (please select all that apply)
- Social Assistance
- Post-secondary Funding
- Employment Insurance
- No source of income
- Other (please specify)
Have you collected Employment Insurance (EI) within the last 3 years?
- Yes
- No
What brings you to Tewatohnhi’saktha? (please select all that apply)
- I am seeking help and advice (i.e resume writing, program information, writing a cover letter etc.)
- I would like to attend an academic program
- I would like to attend a vocational program
- I am looking for information on how to start a business
- I am looking for funding for my business
- I am looking for employment and/or help with my job search
- I was referred by another organization
- Other (please specify)
*
- 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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