CICE Supporting Documentation

Name*
First Last
Email*
Phone*
Student Number:*
Address*
Street Address Address Line 2 City Province Postal Code
Personal Goals
In the box below, list a personal goal you have for yourself.
Education
Ontario Secondary School you attended
Graduation date
MM slash DD slash YYYY
Diploma/Certificate Achieved
Skills
In the box below, list 4 employment skills you have
Experience (work, volunteer or placement) List all completed
Company Name
Address
Street Address Address Line 2 City Province Postal Code
Start Date
End Date
Company Name
Address
Street Address Address Line 2 City Province Postal Code
Start Date
End Date
Certificates and Awards
List any that apply
For questions about this form or if you require an alternate format, please contact cice@durhamcollege.ca.
In accordance with Section 39(2) of the Freedom of Information and Protection of Privacy Act, 1990, the personal information collected on this form is collected under the legal authority of the Ontario Colleges of Applied Arts and Technology Act, 2002 and may be used and/or disclosed to facilitate your participation in the CICE program. . Your personal information may also be used for various administrative, statistical and/or research purposes of the College and/or ministries and agencies of the Government of Ontario and the Government of Canada. If you have any questions about the collection, use and disclosure of your personal information by the College, please contact the Freedom of Information and Protection of Privacy Coordinator, 2000 Simcoe Street North, Oshawa, ON, L1G 0C5, 905.721.2000 ext. 3292.