Vocational Training Application

Procedure

1 Print this document.

2 Sign the application form.

3 Attach documents required to process application:

☐ Attestation of equivalency
☐ Comparative evaluation for studies done outside Québec
☐ Last transcript, prior learning assessment or achievement record issued by the ministère de l’Éducation
et de l’Enseignement supérieur (MEES)
☐ Long-form Birth Certificate issued by Registrar of Civil Status
Must indicate name of parents. Translated into French or English.

☐ Two proofs of permanent residence in Québec

An official document issued by government agencies or departments indicating the address. Ex.: tax statements, municipal
or school tax statements, MEES issued transcripts, bills for public utilities such as electricity, telephone, Vidéotron, driver’s
licence, Medicare card, etc.

☐ Certificat de sélection du Québec (CSQ) or attestation of CSQ issuance

— or —
Citizenship Certificate or Card, Permanent Resident Card or Immigration Document (IMM1000 - 5292 -
5688)
Both sides

→ Admissions will only process your application once all required documents have been received.

4 Mail the signed application form along with documents to the below address.

CIMME - Centre intégré de mécanique, de métallurgie et d'électricité

1100, rue Ducas
LaSalle (Québec)
H8N3E6

Sylvie Guilmette
? Telephone: 514 364-5300 poste 7461 E-mail: sylvie.guilmette@csmb.qc.ca

Service régional d'admission en formation professionnelle www.srafp.com

 APPLICATION IN PREPAID CODE
VOCATIONAL TRAINING -
A - PROGRAM SELECTION
PROGRAM STARTING GROUP
PROGRAM TITLE CODE DATE NAME TRAINING CENTRE SCHOOL BOARD
Électricité 5295 May 25th, 2020 EL200525 Centre intégré de mécanique, CS Marguerite-Bourgeoys
Desired language of teaching: □ French Schedule : □ Day de métallurgie et d'électricité

(Offered in certain programs only) □ English □ Evening Where did you hear about □ Job/Training Fair □ Parent, friend
□ Either One us? □ Guidance counselor □ Other
B - CANDIDATE IDENTIFICATION
FAMILY NAME AT BIRTH OTHER LAST NAMES GENDER BIRTH DATE (YYYY-MM-DD)
AYAD □M □F
FIRST NAME OTHER FIRST NAMES PERMANENT CODE (if you have already studied in Québec)
SAMEH MOHAMED ABDELAZIZ MANSOUR
MOTHER TONGUE LANGUAGE SPOKEN AT HOME SOCIAL INSURANCE NUMBER (receipts taxes and internship)

LAST NAME OF PARENT A (even if deceased) FIRST NAME OF PARENT A BIRTH DATE (YYYY-MM-DD)
□ FATHER □ MOTHER
LAST NAME OF PARENT B (even if deceased) FIRST NAME OF PARENT B BIRTH DATE (YYYY-MM-DD)
□ FATHER □ MOTHER
CITY OTHER PROVINCE (SPECIFY WHICH ONE) OTHER COUNTRY (SPECIFY WHICH ONE)
PLACE OF BIRTH
CAIRO Égypte
CANDIDATE'S EMAIL ADDRESS
sameh.aziz76@gmail.com
STREET NUMBER STREET, AVENUE, BOULEVARD, … APPARTMENT PHONE NO. (999) 999-9999
PERMANENT (main)
ADDRESS TOWN/CITY PROVINCE POSTAL CODE PHONE NO. (999) 999-9999
(other)

C - DOCUMENTS TO BE INCLUDED FOR APPLICATION PROCESSING

• Attestation of equivalency
• Comparative evaluation for studies done outside Québec
• Last transcript, prior learning assessment or achievement record issued by the ministère de l’Éducation et de l’Enseignement supérieur (MEES)
• Long-form Birth Certificate issued by Registrar of Civil Status
Must indicate name of parents. Translated into French or English.
• Two proofs of permanent residence in Québec
An official document issued by government agencies or departments indicating the address. Ex.: tax statements, municipal or school tax statements, MEES issued transcripts, bills
for public utilities such as electricity, telephone, Vidéotron, driver’s licence, Medicare card, etc.
• Certificat de sélection du Québec (CSQ) or attestation of CSQ issuance
— or —
Citizenship Certificate or Card, Permanent Resident Card or Immigration Document (IMM1000 - 5292 - 5688)
Both sides

D - MANDATORY SIGNATURE
In accordance with the Laws protecting access to personal information and documents (L.R.Q., c.A-2.1), I consent to the release of information provided in this application, as well as in the attached documents,
to the school boards chosen, SRAFP and to the MEES for the purpose of planning/management. I authorize the school board to consult my dossier in relationship to the SRAFP system and the MEESR. I give
my consent for the MEESR, through the Director of Civil Status, to verify the information provided. I understand that without issuing consent, the organization(s) concerned cannot process this application nor my
dossier. The candidate, or, should it occur, the parental guardian, can contact the organization holding the candidate's information and request access or to have a correction made concerning personal
information conforming to the Law protecting access to personal information and documents.

CANDIDATE'S SIGNATURE DATE (YYYY-MM-DD)

SIGNATURE OF PARENTAL AUTHORITY (Parent or guardian, if the candidate is a minor - under 18) DATE (YYYY-MM-DD)

E - RESERVED FOR ADMINISTRATION

RÉSIDENT DU QUÉBEC 11 12 13 14 15 16 17 18 19 30 31 32 33 34 35 36 39 40 41 42 43 44 60 61 62 70 71
□ Jeune □ Non admissible 03 □ TDG et préalables non détectés DEP - équivalent secondaire hors Québec 17 □ Situation exceptionnelle
□ Adulte 04 □ CFMS 09 □ 3e 10 □ 4e 11 □ 5e 18 □ Hors programme
01 □ DEP/ASP - Préalables détectés 05 □ DEP avec études postsecondaires 12 □ Att. d'équivalence émise au Canada (Hors QC) 19 □ Lancement/Gestion d'entreprise
14 □ ASP-DEP hors Québec 21 □ Reconnaissance des acquis
Sous condition □F □M □A DEP - Matières sec. requises non détect. 15 □ ASP-DEP préalable non terminé 23 □ DEP-TDG + Préal. en concomitance
06 □ 3e 07 □ 4e 08 □ 5e 16 □ ASP - Expérience/acquis équiv. □F □M Nb. Heures FG : _________________
□ DEP - Unités requises en concom. □ 22a ou 23b
22 26 □ Élève inscrit à une AEP □ Autre : ___________________________________
□F □M □A Nb. heures FG : ________ Code org. : ________________________________J'atteste avoir pris connaissance des documents originaux, présentés pour confirmer la résidence de l'élève au
Verdict : □ Admis □ Admis conditionnellement □ Liste d'attente □ Non admis Québec : □ Carte d'assurance maladie □ Permis de conduire □ Autre : _____________________________

Attestation : ____________ Source de financement : ___________________________

____________________________________________ ______________________________ _______________________________________________ _______________________________________

Signature du responsable des admissions Date Signature du responsable Date