General Information Name First name Phone Where you can be reached most easily Additional phone number Email Email Confirm email City Are you of legal age? Yes No Please provide his or her contact information. If you are a minor, your parent or legal guardian must give their consent and sign the liability release form. Please provide us with their contact information: Name First name Phone number Email Level of education in the fall 2021 or winter 2022 semester Professional (DEP) CEGEP (DEC or AEC) University – 1st cycle University – 2nd or 3rd cycle If you selected: University – 1st cycle Certificate Bachelor’s If you selected: University – 2nd or 3rd cycle Master’s DESS Doctorate 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 (2020-2021 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, 2021 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 2021-2022 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). CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. What code is in the image? Enter the characters shown in the image. Get new captcha!