Community Placement Form

First name *

Your given name.

Last name *

Your family name.

Student number *

Lakehead University e-mail address *

Your Lakehad University e-mail address (@lakeheadu.ca).

Phone number *

Current phone number with area code.

Major(s) *

Your major field or fields of study.

Year level *

Your course level of study.

Term *

Fall

Winter

Preferred placement type/name *

Please outline your career objectives/goals and interests *

i.e. why you would like to take part in the Community Placement course

Please outline any relevant work experience and/or academic and extracurricular activities *

Please attach a current curriculum vitae/resume *

(PDF only)
Files must be less than 10 MB.
Allowed file types: pdf.

Acceptance *

I understand that my overall and program GPA and marks received in relevant courses will be shared with potential Placement Partners as part of the selection process.

Disclaimer *

I understand that by filling out this application it does not guarantee registration in the course. Final decisions are based on a competitive selection process, availability of partners, and the completion of additional items outlined in the Placement Handbook.