General Information Name * First name * Phone number where you can be reached most easily * Additional phone number Email * Confirm email * City * Are you of legal age? * Yes No If you are a minor, we will need the consent of your parent or legal guardian. He or she will also have to sign the liability waiver form at the grants award ceremony and must therefore be present on Saturday, January 23, 2021. Please provide his or her contact information. Name Fist name Phone number Email Level of education in the fall 2020 or winter 2021 semester * Professional (DEP) CEGEP (DEC or AEC) University – 1st cycle University – 2nd or 3rd cycle If you selected: University – 1st cycle SelectMaster’sDESSDoctorate If you selected: University – 2nd or 3rd cycle SelectCertificateBachelor’s I am studying at a school recognized by the ministère de l’Éducation et de l’Enseignement supérieur * I confirm You must be a member of the Caisse Desjardins de Vaudreuil-Soulanges in order to participate in the contest. * I confirm I confirm that I have read the rules and regulations * I confirm Rules and regulations Students who received a Caisse Desjardins de Vaudreuil-Soulanges grant the previous year (2019-2020 contest) are not eligible for this contest, unless they have changed their level of education since then. Mathematical skill-testing question: 100 ÷ 2 + 25 - 5 = * Registration deadline: November 30, 2020 Authorization By clicking on "Send", I consent and authorize Caisse Desjardins de Vaudreuil-Soulanges to use the information provided in this form for the organization of the Desjardins 2020-2021 grants award activities and for any promotion or publicity related to this event. Questions? 450-455-7901. We will contact you within 24 hours (or the next business day).