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RYAC

Metis Youth

Manitoba Metis Federation

Program Intake From 2

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Program Intake From 2

Client Registration Form

First Name & Middle Initial
Family Name
Gender
- Male
- Female
Marital Status:
- Married or Equivalent
- Single
- Single Parent
Number of Dependents
Age of Dependents
Date of Birth
Age
Employment Status:
- Employed
- Unemployed
- Student
Language preference:
- English
- French
Other (Specify):
- Metis
- Inuit
- Non-Status
- Non-Aboriginal
- Status
Metis Membership Number
MMF Local
MMF Region
Address
Street Address City ZIP / Postal Code
Email Address
Home/Cell Number
Have you previously been sponsored by the MMF for activities?
- Yes
- No
If yes, which activities?
Start date:
End date:
Do you have any health problems we should be aware of?
- Yes
- No
If yes, please specify:
Do you consider yourself to be a person with a disability?
- Yes
- No
If yes, please specify:
Do you need any special equipment?
- Yes
- No
If yes, please specify:
Highest Level of Education Attained:
Primary / Secondary (Grade):
Year Attained:
Diploma or GED Received?
- Yes
- No
If you have attended Post-Secondary studies did you obtain a:
- Certificate
- Diploma
- Degree
- Bachelors Degree
- Masters Degree
Name of Course attended:
Program Length:
If you are currently attending Post-Secondary studies please provide:
Name of institution:
Expected completion date:
Permission to use Photograph/Video
Subject: UPIP Funded Activities
I grant to Manitoba Metis Federation, its representatives and employees the right to take photographs/videos of me and my property in connection with the above-identified subject. I authorize Manitoba Metis Federation, its assigns and transferees to copyright, use and publish the same in print and/or electronically.
I agree that Manitoba Metis Federation may use such photographs/videos of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content.I have read and understand the above:
Signature:
Date:
Printed Name:
Signature, parent or guardian (if under age 18):
Date:
FOR STAFF USE ONLY: What services are being provided or what project is UPIP client participating in.

About Us

The Manitoba Métis Federation is proud to provide and serve the Metis citizens of Manitoba.

The Manitoba Métis Federation (MMF) is the official democratic and self-governing political representative for the Métis Nation.

Contact Information

150 Henry Avenue, Winnipeg, Manitoba
204-586-8474
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