Indigenous Student Centre - User Agreement - SDC

Indigenous Student STEM Access Program Application

Please complete the form below to apply for the Indigenous Student STEM Access Program (ISSAP).

If you have any questions, our team can be reached at oii-forms@uwo.ca.

First Name*

Middle Name (If Applicable)

Last Name*

Street Address*

Apartment/Unit #(if applicable)

City*

Province/State*

Country*

Postal/Zip Code*

Phone Number*

Email Address*

Preferred Method of Communication*

Phone

Other

Please select your preferred method of communication. If you have another preferred method of communication please select Other.

If you selected Other, please indicate your preferred method of communication (guardian, alternate phone, etc.)

Date of Birth

Gender

Do you identify as Indigenous?*

Yes

Yes, but need assistance with proof of ancestry

If you have identified as Indigenous, the Indigenous Student Centre will reach out to you to confirm your proof of ancestry.

Indigenous Community Name

Previous Western Student Number (if applicable)

Start Term*

September 2025 - Science

September 2025 - Engineering

Current Level of Education*

Grade 11 - Completed

Grade 12 - In Progress

Grade 12 - Completed

What do you hope to study after your preliminary year?*

Engineering

Science

To verify that you are a human, please enter the text below:

Click submit to complete the form.

The personal information collected pursuant to this user agreement form is collected under the authority of the University of Western Ontario Act, 1982, as amended, and will be used for the Purpose(s) of assessing your application for the Indigenous Student STEM Access Program (ISSAP). Please direct questions about this collection, use, or disclosure of personal information on this form to the Director, Indigenous Student Centre, (519) 661-4095.

Return to Indigenous Student Centre Website