Collaborative Education Alternative Program
Qualicum School District
Located in Winchelsea Learning Centre
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140 Renz Road, Parksville, BC, V9P 1E8| Phone: 250-248-2969| Contact Us
Registration

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Student's Full Name *
Last, First Name)
Student Date of Birth *
Select a date from the calendar.
Provide the student Date of Birth in M/D/YYYY format.
Current or Highest Grade Level Attained *
Please indicate the current or highest grade level attained, K to 12
Contact Phone Number *
Please provide a phone number at which the parent or adult student can be contacted.
Contact Email Address *
Please provide an email address at which the parent or adult student can be contacted.
Program or Course *
Please provide the following: For Full-time enrolment (CEAP is the only or main school attended - Provide the desired grade level). For part-time enrolment (Grades 8 - 12 only) - Provide the first course that you wish to take, knowing that other courses can be added later.
Comments or Enrolment Information
Please provide any pertinent information about yourself or the learner that will assist us in creating the best possible learning experience.
Grade Level Desired
For full-time students: Enter the overall grade level at which the student will be registered for in this registration.
Parent/Guardian Name *
First, Last Name
Present School or last school attended *
Attachments
    Captcha *