Registration Form

NOTE:  Please be sure to use a current email address and update as required

 

Register: Update:
First Name:
Last Name
Male: Female:
Maiden Name (if applicable):
Address:
City:
Province (if applicable):	--Please select a province-- Other / Not in Canada Newfoundland and Labrador Alberta British Columbia Manitoba New Brunswick Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory
Country:	--Please select a country-- Canada USA UK Albania Algeria American Samoa Andorra Angola Anguilla Antigua Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Barbuda Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire Botswana Brazil British Virgin isl. Brunei Bulgaria Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Rep. Chad Channel Islands Chile China Colombia Congo Cook Islands Costa Rica Croatia Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Faeroe Islands Fiji Finland France French Guiana French Polynesia Gabon Gambia Georgia Germany Ghana Gibraltar Great Britain Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Irak Iran Ireland Ireland, Northern Israel Italy Ivory Coast Jamaica Japan Jordan Kazakhstan Kenya Kuwait Kyrgyzstan Latvia Lebanon Liberia Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar/Burma Namibia Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Norway Oman Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Puerto Rico Qatar Reunion Rwanda Saba Saipan Saudi Arabia Scotland Senegal Seychelles Sierra Leone Singapore Slovak Republic Slovenia South Africa South Korea Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tanzania Thailand Togo Trinidad-Tobago Tunisia Turkey Turkmenistan United Arab Emirates U.S. Virgin Islands U.S.A. Uganda United Kingdom Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Wales Yemen Zaire Zambia Zimbabwe
Postal Code (A1A1A1):
Email Address:	NOTE:Be sure to use an email address you will be using after graduation.
Telephone Number:(xxxxxxxxxx):
Program of Graduation:
Year of Graduation:	--Year-- 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900
Student ID Number:
Campus Location:	--Please select a campus-- Baie Verte Stephenville Bonavista Burin Carbonear Clarenville Corner Brook DL-Virtual Prince Philip Dr. Gander Grand Falls-Windsor Labrador Placentia Port aux Basques Qatar Ridge Road Seal Cove St. Anthony Other
Campus of Graduaton if other:
Referred by:
Send me a CNA Alumni Pin:
I would like to share my CNA Alumni success story, please contact me:
I have previously registered with the CNA Alumni Association and am updating my information:
I have graduated from the college since 2008, and am updating my information:
I am interested in learning more about the New Ambassador Program:
How did you hear about the Alumni Association?:	--Please select an option-- CNA Website Newspaper Television Radio At Graduation CNA Faculty/Staff CNA Alumnus Facebook Ad Facebook Wall Posting Twitter Digital Billboards VOCM The Telegram CNA Alumni Email Other
Are you currently working in your field of study? If so, please share the following information:
Employer:
Job Title:

CNA Ambassador Program!

Do you want to become engaged in meaningful volunteer opportunities at College of the North Atlantic? Such activities include:

• - Assisting on recruitment visits to schools
• - Volunteering at College Day, Career Fair, Skills Canada, etc.

These activities provide real opportunities for prospective students to hear first- hand what college life is like, and to see how others have succeeded.
For more information, please contact Lisa Shallow at lisa.shallow@cna.nl.ca or call 709.758.7515.

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The information requested on this form is collected under the authority of the College Act, 1996 (SNL1996 CHAPTER C-22.1 ), and will be used in the administration of the CNA Connect Alumni Program. The information will be shared with personnel from CNA’s student development office at your selected campus. All personal information will be stored in accordance with our normal network and information security measures.

For details on the use and disclosure of your information, please contact Lisa Shallow, Manager – Alumni & Advancement at (709) 758-7515. For more information about the ATIPPA please visit www.cna.nl.ca/about/atippa.asp .