Centre For Newcomer Integration

Full-Time Studies
Suite E201 - 319 Elgin Avenue
Winnipeg, MB R3A 0K4
Tel: 204-945-6151
Fax: 204-948-3214
eal@rrc.ca

Application form
If you need help filling out this application form, contact our staff or please call 204-945-6151

Using your WELARC referral, complete the information below:

WELARC Client ID #: Phone Number:

Given Name:

Surname:

Email Address:

Please provide the Canadian Language Benchmark scores you received at WELARC:
Listening Speaking Reading Writing

1. Have you been referred to RRC Polytech by WELARC?

□ Yes
□ No

2. Are you ready to start classes right away?

□ Yes
□ No - please write the date when you are ready to start classes (day, month, year)

3. How many hours a week do you want to study?

□ 20 hours (M-F 9:00 am to 1:00 pm)
□ 15 hours (M-F 9:00 am to 12:00 pm)
□ 12 hours (M-Th 9:00 am to 12:00 pm or 6:00 pm to 9:00 pm)
□ 9 hours (T-Th-F 6:00 pm to 9:00 pm)
□ 9 hours (M-W-F 6:00 pm to 9:00 pm)
4. What is the best time for you to attend classes? Select all that apply
□ Mornings
□ Evenings

5. Are you currently working?

□ No
□ Yes - casual / shift work 9 hours
□ Yes - regular schedule

6. Do you have access to High-Speed Internet?

□ Yes
□ No

7. Do you have a computer with a webcam? (desktop or laptop)?

□ Yes
□ No

8. Do you need childcare?

□ No
□ Yes
9. In the future. How would you like to study? Select all that apply:
□ Online only (4/5 - 5/6 - 6/7 - 7/8)
□ Blended (in person and one day online)
□ In person Only

Thank you for filling out this application form. We will contact you by email to invite you
for classes. If you have questions about your application, please call 204-945-6151 or
email LTC-IRCC-Info@rrc.ca

NOTES: