PLAR Registration Form

First Name:

Last Name:

Were you a former Mohawk College student?

Yes

If Yes, please provide your former last name if it has since changed and date of birth

Mohawk ID: (If you were not a former Mohawk College student, please enter 000000000)

Email:

Date of Birth

Street Address

City/Town

State/Province

ZIP/Postal Code

Country

Phone:

Are you registering for a course in a:

Full-time program

Continuing Education program

Full-Time Programs

Continuing Education Programs

Course Code and Name:

Please provide up to 5 course codes and course names you are requesting.

Course Code and Name:
	Course Code and Name:	Item weight

more items

Course Code and Name:

Please provide up to 5 course codes and course names you are requesting.

Course Code and Name:
	Course Code and Name:	Item weight

more items

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