Indigenous Self-Identification Form

This is a voluntary declaration.

Preferred name
Student number
ontariotechu.net email
Date of birth Date of birth / MM / DD YYYY
Are you of Indigenous Ancestry?
*Indigenous ancestry is defined as "status and non-status First Nation, Métis, and/or Inuit". Proof of Indigenous membership or ancestry is NOT required.

Are you of Indigenous Ancestry?
*Indigenous ancestry is defined as "status and non-status First Nation, Métis, and/or Inuit". Proof of Indigenous membership or ancestry is NOT required. Yes No
Please identify yourself as:

Please identify yourself as: First Nation Métis Inuit Prefer not to disclose
Please indicate if you would like to have proxy card access to Mukwa's Den.

Please indicate if you would like to have proxy card access to Mukwa's Den. Yes No
Would you like to be on the Indigenous Student Services mailing list?

Would you like to be on the Indigenous Student Services mailing list? Yes No