Ecole de technologie superieure, Services aux diplomes et a la philanthropie

Personal information

By filling in this application form, I confirm that I have read the eligibility conditions.

After reviewing your application, you will receive an e-mail confirming your eligibility and informing you about the distribution schedules.

You should include your current address.

ÉTS E-mail

ÉTS E-mail confirmation

Title

First name

Last name

Country

Phone

ÉTS Food Bank

Universal access code (AB12345)

Year of birth

Legal status

ÉTS email

Transaction

Food Bank (3 hampers) $15.00 / unit

Subtotal: Total:

Family Information

Civil/parental status

Financial information

You should have a houshold revenue (after taxes) under the following limits

Provide the main household revenue source

What type of housing do you occupy?

Reasons to request food help

Statement

It is important to answer all the questions. All information provided in this form will be kept confidential.

I declare that the personal, family and financial information provided is exact.

I confirm having read the eligibility conditions.

Total:

Personal information

Your personal information is collected through this electronic form and will be used by the École de technologie supérieure (“ÉTS”) for the following purposes: processing your subscription for the food bank and updating the database of the ÉTS Alumni and Philanthropy Service.
Providing this personal information is mandatory. If you do not consent to the collection or processing of your personal information, ÉTS will not be able to process your transaction. Under the provisions of the Act respecting access to documents held by public bodies and the protection of personal information (R.L.R.Q. c. A-2.1), you have the right to access and correct your information. Please note that your personal information may also be shared outside Quebec.

Consent to the collection and use of your personal information

By checking this box, I confirm that I have read and understood the information provided regarding the collection and use of my personal information, and I consent to its use and disclosure as outlined in this form. I confirm that I have read the instructions accompanying this form. To the best of my knowledge, the information provided is accurate and complete.

I consent to the collection and use of my personal information as described in this form.

Payment

TOTAL amount

$15

Credit Card (Visa or Mastercard)

Please note that only canadian Visa and Mastercard are accepted.

Credit Card Number

Card Expiry

Card Security Code

Comments

Charitable registration number :

121943716 RR 0001

Time remaining in your session: 20