Caution: JavaScript execution is disabled in your browser or for this website. You may not be able to answer all questions in this survey. Please, verify your browser parameters.
Contact Info
(This question is mandatory)
Your first (given) name
(This question is mandatory)
Your last (family) name
(This question is mandatory)
The gender you identify with
(This question is mandatory)
Your current age
(This question is mandatory)
Do you have a cell phone?
(This question is mandatory)
Please enter your full cell number (e.g. 902-300-1234)
(This question is mandatory)
Please enter your home telephone number (e.g. 902-542-1234)
(This question is mandatory)
Your email address
(This question is mandatory)
Your permanent address
(This question is mandatory)
Your program at Acadia
(This question is mandatory)
Your full student number (e.g. 000851394, 100123456)
(This question is mandatory)
Your current program year
(This question is mandatory)

Do you have any serious medical conditions that we should be aware of?

e.g. heart condition, seizure disorder, severe allergy, etc.

 
Close