FastStart Intake Form

Name*
First Last
Student Number*
Email*
Telephone Number*
City*
City
Program*
Program Start Date*

Year
Month
Day
Anticipated Program End Date*

Year
Month
Day
Company name
Describe your business idea*
How did you hear about us
- Class visit
- Faculty/staff
- Referral
- Digital signage
- Social Media
- Website
- Other
Other*
Newsletter Signup
- I want to sign up for the FastStart Newsletter
Consent
I consent to Durham College providing me with email communications regarding Durham College programs, services and events. I may unsubscribe from these communications at any time by following the unsubscribe instructions contained in every Durham College email or by sending a request to casl@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 develop FastStart programming and to facilitate your involvement in programming and activities related to FastStart. 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.