Le français en milieu de santé

Registration Form

WINTER 2018 (18H) – Program 2

Please fill out form and then print.

These courses are offered through Université deSaint-Boniface’s
Continuing Education Division.

Former Student – Last level completed:

New Student – Telephone number where we can reach you

for a placement interview:

USB Student Number (for office use only)

If your position, facility or program is designated bilingual, you should be applying for Program 1. Not Sure? Call 204-235-3986

Level / Mondays
5 pm – 8 pm / Tuesdays
5 pm – 8 pm / Wednesdays
5 pm – 8 pm / Thursdays
5 pm – 8 pm
January 8to March 26
(no class on February 19) / January 9 to March 20 / January 10 to March 21 / January 11 to March 22
Beginner 1 (Telehealth) / (USB)
Beginner 2 (Telehealth) / (USB)
Beginner 3 (Telehealth) / (USB)
Beginner 4 (Telehealth) / (USB)
Intermediate 1(Telehealth) / (USB/SBH)
Intermediate 2 (Telehealth) / (USB/SBH) /
Intermediate 3 / (*Online)
Intermediate 4 / (*Online)
Avancé
(thème : Passages dans le temps) / (USB)
Perfectionnement
(after having completed three sessions at the Avancé level) / (USB) 6 to 9 p.m.
Grammaire et communication: Au travail / (USB) 6 to 9 p.m.
Communication orale :
À votre avis
Last name First nameHome phone numberWork phone numberCell phone number
AddressCity/Province Postal code
Personal e-mail address Work e-mail address
PLEASE CHECK YOUR E-MAIL REGULARLY AS COURSE CONFIRMATIONS WILL BE SENT BY E-MAIL.
Please be sure to check your “junk e-mail” folder as sometimes a new email address can be tracked as spam.
By registering for this course, I consent to the Division de l’éducation permanente’s sharing information with WRHA French Language Services aboutmy enrolment status, my presence in class and my final results.
This personal information is being collected under the authority of TheUniversité de Saint-Boniface Act. It will be used for the purposes ofadministeringLe français en milieu de santé and Telehealth programs. It will not be used or disclosed for other purposes, unless permitted by the Freedom of Information and Protection of Privacy Act (FIPPA). If you have any questions about the collection of your personal information contact the FIPPA/PHIA Coordinator’s Office (204-237-1818, extension 398), Service des archives de l’Université de Saint-Boniface, 200 De la Cathédrale Avenue, Winnipeg, MB R2H 0H7.
May we send you email messages about workshops offered by WRHA French Language Services? Yes No
Can USB send you email messages about courses offered by the Continuing Education Division? Yes No
Language Proficiency
Is French your first language? Yes No
Have you any knowledge of French Yes No
Did you study French in School? Elementary Secondary level Post-secondary
Do you have supplemental French Language TrainingSecondary levelWhen and where?
If known which level are you currently registering for?
Your evaluation of language proficiency (check one):
Can’t speak French at all (Call 204 – 237-2889 to discuss preliminary training options)
Can speak a few memorized sentences (Call 204-237-2889 to discuss preliminary training options)
Can speak a few memorized sentences
Can talk on very general topics – weather etc.
Can talk on a variety of topics but lack spontaneity and accuracy
Can talk on a variety of topics with ease
Can handle uncomplicated work related matters
Can have in depth conversations on work related matters
New students: If selected, you will receive a phone call in French from a representative of l’Université de Saint-Boniface to determine your course level.
Please note that with the exception of the Perfectionnement level, all classes focus primarily on spoken French.
Position Details
Place of Employment (Please clearly indicate)Program/Service:
Facility/agency Current Position:
If you hold multiple positions please indicate:
Your position is: Permanent Term: if so, since when Full-time Part-time If PT, EFT
Years of service
Your position is bilingualYes No (If yes, you should be applying for Program 1)
Are you in direct contact with
Patients Residents External Clients Public Media None
How often would you have occasion to speak with francophone patients, clients, residents and the public? (Check one)
Once a day Several times a day Once a week
Several times a week Occasionally but in a key role.Please explain:
Name of your Manager/Supervisor: Phone Number:
As spaces are limited, please provide any further information that may be helpful in assessing your application.