Health Care Career Training - Applying to the Brampton Campus

Personal Information

First Name *

Last Name *

Gender *

Male

Female

Birthdate ( mm / dd / yyyy ) *

Address *

City *

Province *

Postal Code *

Phone *

Alternate Phone *

Email Address *

Are you a Canadian citizen? *

Yes

No

If no, are you a permanent resident? *

Yes

No

How did you hear about Medix School? *

Are you presently working? *

Yes

No

If so, are you satisfied with your present job or occupation? *

Yes

No

If no, is it because of...

Current Employer

Position

Start Date

Level of education *

The last year I attended school was ... *

I am interested in ... *

I would like to attend ... *

Is there anything you would like to tell us?