First Nations, Métis, and Inuit Voluntary and Confidential Self-Identification
 
Trillium Lakelands District School Board is committed to building meaningful relationships with Indigenous families, students, parents, Elders, Senators, and Knowledge Keepers to further support our students and staff. We honour and celebrate the rich and vibrant cultural traditions, histories and contributions of Indigenous Peoples of Turtle Island.
 
Parents, guardians, and students are encourage to voluntarily and confidentially disclose Indigenous ancestry. No proof of ancestry is required and anyone with status and non-status ancestry is encouraged to identify.
 
For more information about Indigenous Education and self-identification visit www.tldsb.ca or call 1-888-526-5552.
 
We may reach out to verify your contact information.
 
* Required
 
 
Email Address *
 
 
Parent Name
** We may reach out to verify your contact information.
 
 
 
Parent Phone*
 
 
School Name *
 
 
 
Student Name
Last Name * First Name * Middle Name
 
 
 
Student Number
 
 
 
Date of Birth *
 
 
 
Grade *
 
 
 
I consider my child to be of Indigenous Ancestry *
 
 
 
The categories that apply to my child are checked below *
 
 
 
Parent / Guardian / Student 18+ Confirmation I have read the Trillium Lakelands District School Board procedure (find it here) for Indigenous Self-Identification and consent to identification of myself/child as having Indigenous ancestry. I understand that identification is voluntary and that I may withdraw my consent at any time by providing written instruction to the School Principal, at which time any record of myself/child Indigenous Self-Identification shall be removed from the Ontario Student Record (OSR). 
 
 
 
Insert your name below to confirm that you have read and agree with the above statement. *
 
 
 
Privacy & Personal Information Collection Personal information is collected pursuant to the Trillium Lakelands District School Board Policy name and number in accordance with the Ministry of Education First Nations, Métis and Inuit Education Policy Framework and the Municipal Freedom of information and Protection of Privacy Act. Information collected on this form shall be included in the Ontario Student Record (OSR) and shall be used for the provision of education services for students in accordance with the policy. Question regarding information collected on this form or the policy may be referred to the Principal of the school.
 
 
 
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