WAHSA Distance Education Centre

Legal Last Name *(Required)

Legal First Name *(Required)

Other/Preferred First Name

Middle Name(s)

Other/Maiden Names:

Gender *(Required)

Status Card

Your First Nation Community *(Required)

Mailing Address or PO Box Number *(Required)

Street or Alternate Address

Town/City *(Required)

Province *(Required)

Postal Code *(Required)

Primary Phone

Secondary Phone

Email Address *(Required)

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Please list schools you have previously attended, starting with the most recent

Schools

School Name *(Required)

City *(Required)

Credits Earned (if known)

Year *(Required)

Online Registration Form