Apply Online Step 1 of 2 Important information, please read before proceeding. Note: Section A - Personal Information and Section C - Sponsor & employment information (must be printed & faxed to acquire sponsor signature) must be completed. Section B - Personal History for CAT Series Applicants must be completed if applying for the CAT Series. Section A - Personal Information: *First Name *Last Name Middle Name Have you taken training under another name? If yes, please provide. *Address *Reserve, Town/City, Province *Postal Code *Telephone Fax Email Address Male Female Gender Status Indian Treaty Indian Non-status Indian Metis Inuit Other Aboriginal Heritage Band Name Band Number (10 digits) Elementary (K-6) Jr. High (7-9) Sr. High (10-12) College/Technical University Masters Degree Bachelors Degree Doctorate Degree Last Grade or Degree completed   Have you been treated with any of the following Alcoholism Epilepsy Mental Illness Diabetes Heart Disease Other If Other, please specify Length of Sobriety Are you on any medications? If so, please list Doctor Name Doctor Phone #     *Course(s) Applied For: Community Addictions Training Advanced Councellor Training Program Management Training of Trainers Aboriginal Addictions Services Contract Aboriginal Addictions Services Diploma Community Wellness Certificate Are you applying for our Summer Session? Yes No Have you previously taken any courses offered by Nechi Institute? Yes No     Section B - Personal History for CAT Series Applicants:     Please describe your history with addictions: max. 1000 characters   Do you have any experience in the field of Human Services or Management? If so, please provide details: max. 1000 characters   Describe your employment situation and how you think Nechi training will assist you personally or professionally: max. 1000 characters   Have you taken any Adult Education Courses? If yes, please provide details: max. 1000 characters   When you have finished please click the SEND button to submit your form.