A.IDENTIFICATIONPlease check one: Miss Mrs. Ms. Mr.

1.Full Legal Name:

(Please print)SurnameFirst NameMiddle Name(s)

2.Residence Address

StreetApt. No.

CityProvince/State/TerritoryCountryPostal/Zip Code

3.Residence Tel:( ) ______Bus. Tel: ( ) ______E-Mail: ______

Address published on Web Site: YesNo(If you choose not to have your address published, only your name will be included on the listing.)

B.HISTORY

1.If you have previously been enrolled in an Intern Architect Program or held any type of associate status with another Provincial Association, please identify.

C.STUDENTS ENROLLED IN AN ACCREDITED UNIVERSITY IN CANADA OR THE UNITED STATES OF AMERICA

  1. Pre-professional degree program in architecture

I enrolled in the pre-professional degree program at ______

School or Department of Architecture (University)

in ______
Year

  1. Professional degree program in architecture

I enrolled in the professional degree program of architecture at______

School or Department of Architecture (University)

in ______

Year

D.SYLLABUS STUDENTS

I enrolled in:  the RAIC Syllabus Part 1 OR  the RAIC Syllabus Part 2 in Month Year

MENTOR – SYLLABUS STUDENTS ONLY

Name:

(Please print) SurnameFirst Name

Firm name

Address:

Street Suite No.

______

CityProvinceCountryPostal /Code


Consent Form

Under the Personal Information Protection and Electronic Documents Act (PIPEDA) for the collection, use, disclosure and retention of personal information collected by the Ontario Association of Architects in the course of its commercial activities.

Name:

(please print)

Address:

City:Prov./State: Postal/Zip Code:

Telephone: E-mail:

This Consent Form provides the Ontario Association of Architects (OAA) with permission to forward your personal information as set out above to the following organization as it relates to the commercial activities of the OAA.

I hereby consent to the release by the OAA of my name, address*, telephone number and e-mail address to the organization offering the OAA Group Insurance Plan to architects licensed by the OAA and other classes of persons with the OAA for the purpose of enabling this organization to contact me. / Yes No

* Note that the address includes the City, Province/State and Postal/Zip Code.

I acknowledge that I have the right to amend this Consent Form in writing.

SignatureDate


111 Moatfield Drive, Toronto, Ontario M3B 3L6

Telephone 416-449-6898 Fax 416-449-5756

There is no cost for holding Student Associate status with the OAA

Fee

Student Associate fee(includes HST) / FREE

Updated November 15, 2014