Online Registration

Last Name(required)

First Name(required)

Date of Birth(required)

Gender(required)

Male

Female

Street Address | P.O. Box(required)

City/Town(required)

Province/Territory(required)

Postal Code(required)

Home Telephone

Cell or Alternate Phone(required)

Email address(required)

Ancestry

Indigenous

Visible Minority

Metis

Inuit

Caucasion

Select the your ancestry from the options listed.

EMERGENCY CONTACT - Person to contact in case of emergency.

Name

Relationship to you:

Street/P.O.Box #:

City/Town

Province/Territory

Postal Code

Home Phone

Cell Phone

Do you have any medical conditions? If yes, please specify.

Yes

EDUCATION

University Grad

College/Tech School Grad

High School Graduate

Less than Grade 12

SPONSORSHIP/FUNDING CONTACT INFORMATION (If available)

Company/Organization

Name:

Email address

Telephone

Fax

Street/P.O.Box No:

City/Town

Province/Territory

Postal Code

Please Select Your Desired Program:(required)

240 Hour HEO Program ($14,088 for 4 weeks training/certificate on Excavator, Dozer, Grader and Articulated Truck OR Loader)

16 Hour Competency Course ($1,800 for review/evaluation/certificate on 2 pieces of equipment of your choice. Add $300 per additional piece after that)

Select Desired Piece(s) of Equipment for 16 Hour Competency Course:

Excavator

Dozer

Grader

Articulated Truck

Loader

Please Select Your Desired Program Start Date:(required)

REFERRAL INFORMATION

Newspaper Ad

Internet

Family/Friend

College Guide

Other

How did you hear about our Institute and the program we offer?

CONFIRMATION

Program Schedule

Program Outline

Training Institute Policies and Procedures

Student Financial Responsibilities

Payment Information & Fee Schedule

Please confirm that you have received, understood, and acknowledged all information provided by the Institute. (all information can be found on website)

PLEASE NOTE: The School operates on a first come first served basis; therefore, those who provide their funding/finance approvals or payment of total program cost first, will be secured a spot in the program, until the program reaches maximum capacity. A minimum of 3 individuals is required to run a program. If this requirement is not met and the selected intake date is cancelled, we will issue you a refund (including the non-refundable registration fee) or move you to the next available intake date. If the selected intake date becomes full prior to your meeting the official enrolment requirements, we will issue you a refund (NOT including the non-refundable registration fee) or move you to the next available intake.(required)

I HEREBY submit the $150 non refundable registration fee (unless being covered through funding or being placed on our cancellation list) to have my application processed. Please note that this is not an additional charge, and once paid, will be deducted from the total program cost. Acceptable methods of payment would be cash, cheque or e-transfer to pti@sasktel.net. We do not accept debit/credit transactions at this time. A money order can be purchased with debit/credit at any Canada Post office and the money order can be forwarded to us. Our MAILING ADDRESS is Box 30029 1624 33rd ST W, Saskatoon, SK S7L 7M6. Our PHYSICAL LOCATION is SW of Saskatoon, SK (near Pike Lake Provincial Park). Please contact us for a map w/directions if needed. ONCE RECEIVED AND PROCESSED we will provide you with a CONFIRMATION OF REGISTRATION letter which you will want to provide to your financial institution or potential source of funding to assist with any loan, RESP/REF, or funding application. Thank you!

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Practicum Training Institute Inc.

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