Skip to content

CICE QUESTIONNAIRE

Complete the questionnaire as soon as possible and submit it to us BEFORE your interview date.

The questionnaire is used as part of the discussion during the CICE Interview.

If we do not have a completed questionnaire for the interview, we will be unable to continue with the interview

PART A: APPLICANT QUESTIONNAIRE

Applicant Information

Use the same Last Name, First Name information you entered on your initial application form.

Please Note: To be eligible for the CICE Program, you must be at least 19 years old by the first day of college classes (the day after Labour Day).

Reference Information

Provide information for two individuals to act as references. The reference will complete a confidential online form. The two individuals you choose should be able to comment about your academics, your motivation to come to college, your strengths and your needs. (For example teacher, education assistant, co-op supervisor, agency worker, etc.) Personal references such as a family friend, relative or neighbor would not be a strong reference for this application.

Reference 1
Reference 2

New or Updated Documents

Provide any updated or new documents to support your application. ONLY upload documents that are different from what was uploaded in your initial application submission. Duplicates are unnecessary.

Updated Resume Upload (PDF, Word only)
Please click on the box below and select a file from your computer to upload.
Updated or New Individual Educational Program (PDF, Word only)
Please click on the box below and select a file from your computer to upload.
Updated or New Psycho-Educational Report (PDF, Word only)
Please click on the box below and select a file from your computer to upload.

TELL US ABOUT YOURSELF

TRANSPORTATION

How did you get to school?

How did you get to work/co-op?

TELL US ABOUT YOUR EDUCATION

What schools have you attended?

Check the kind of support (help) you need at school: (Check all that apply)

How much time do you or did you usually spend doing your homework?

How do you take notes in class? (Check all that apply)

I take notes:

Do you have a home computer that you can use?

Do you use email?

TELL US ABOUT YOUR MOST RECENT VOLUNTEER /WORK EXPERIENCE If applicable

Where did you work?

Paid

Volunteer

Co-op

TELL US WHAT YOU WANT TO LEARN ABOUT

Looking at the chart below, check off what is interesting for you.

The dollar sign ($) means there is an extra cost for equipment and/or uniform.
CHOICES LIKE DISLIKE
Travel and tourism services
Cooking in a restaurant $
Serving food and beverages $
Operating a business
Working with small children
Caring for senior citizens
Caring for people who are ill
Various types of recreation programs
Fitness and healthy lifestyles
Planting and caring for flowers and trees $
Writing scripts and learning about the history of film
Radio station formats and announcing techniques
Writing stories for newspapers, magazines or TV news
Taking photographs and using Photoshop
Working in a spa
Other

NOTE: Students participating in elective classes at Lakeshore are required to travel independently between the Lakeshore Campus and the North Campus. All core CICE classes are located at the North Campus

From the list on the chart above, list your top three (3) choices.

**These choices will be reviewed with you during the interview. This will help us decide what elective program you are interested in, for your first semester at college

Did anyone help you to fill out this Questionnaire?

Are you connected with a service agency (e.g. Community Living, Vita, etc?)

PART B: PERSONAL STATEMENT

Your Personal Statement can be written, expressed through art, music, or video – any way you feel would answer the question:

“Why do you want to come to Humber College?”

Please bring a copy of your Personal Statement to your interview. Any artwork will be returned at the end of the interview.

*Note: Music or video statements must not be longer than three (3) minutes; please bring your own device to present your statement (i.e. Laptop, iPad, etc…).

Although we recognize that many students might benefit from a program like ours, we often have more qualified students than we have space available and not all students will be accepted into the program. If you are not accepted, you are welcome to reapply the following year.

When you sign this application, it means that you are giving us permission to talk about you.

I certify that the above information is true and complete. I understand that any false or incomplete information submitted in support of my application may invalidate my application.

Humber College will collect your personal information in accordance with its role as a post-secondary institution for the provision of the Community Integration through Cooperative Education (CICE) Program.

We need to collect and use this information during the CICE registration process in order to assess your eligibility and register you for the program. Information collected by Humber College may be used or disclosed for various educational, administrative, safety, security, research and/or statistical purposes of Humber College and/or Ministries and agencies of the Government of Ontario and the Government of Canada in compliance with its role as a post-secondary educational institution. For clarity, the information collected from your CICE Application and interview may be shared with Humber College Accessibility Services.

Humber College does not sell, assign, lease or otherwise disclose or permit disclosure of your personal information except as: permitted by this statement; with your prior written consent or as required to comply with legal and regulatory requirements.

By submitting your personal information and registration form, you consent to the collection, use and disclosure of the information by Humber College in accordance with the above.

Questions about the collection, use and disclosure of student information by Humber College should be directed to: Chief Privacy Officer, Office of the Associate Vice-President, Legal and Risk Management, 205 Humber College Boulevard, LRC 6th Floor, Toronto, ON M9W 5L7

Once you click the Submit button, your Questionnaire will be submitted and you will be sent a confirmation email.

loading icon

Submitting....
Please do not close the window!