<p> E D U C A T I O N A N D T R A I N I N G B R A N C H M É T I S Q U AL I F I C AT I O N F O R M</p><p>Region Contract #</p><p>NAME: Last Name First Name Initial</p><p>ADDRESS: Street Address/PO Box City Postal Cod e</p><p>Complete either PART A or PART B: PART A: MÉTIS NATION OF ONTARIO CARDHOLDER MNO Card Registry #: As a citizen of the MNO, I do hereby authorize the Registry Verification Officer of the Métis Nation of Ontario to access my Registry file for Verification purposes. Signed:</p><p>PART B: MÉTIS MNOET APPLICANT GENEALOGICAL INFORMATION PLEASE NOTE: List maiden names of women. Please attach any documentation that supports your Métis ancestry.</p><p>Mother’s Genealogical Line:</p><p>Name of Mother: Does your mother have Aboriginal Ancestry? Yes No</p><p>Place of Birth: If Yes: Métis First Nations Inuit</p><p>Name of Mother’s Mother: Does your mother’s mother have Aboriginal Ancestry? Yes No</p><p>Place of Birth: If Yes: Métis First Nations Inuit</p><p>Name of Mother’s Father: Does your mother’s father have Aboriginal Ancestry? Yes No</p><p>Place of Birth: If Yes: Métis First Nations Inuit</p><p>Father ’s Genealogical Line:</p><p>Name of Father: Does your father have Aboriginal Ancestry? Yes No</p><p>Place of Birth: If Yes: Métis First Nations Inuit</p><p>Name of Father’s Mother: Does your father’s mother have Aboriginal Ancestry? Yes No</p><p>Place of Birth: If Yes: Métis First Nations Inuit</p><p>Name of Father’s Father: Does your father’s father have Aboriginal Ancestry? Yes No</p><p>Place of Birth: If Yes: Métis First Nations Inuit</p><p>I hereby affirm that I am Métis I reside in the Province of Ontario I am not registered as an Indian under the Indian Act or as an Inuk on an Inuit registry.</p><p>Privacy and confidentiality Policy and Authorization for use of information This information is collected under the authority of the Métis Human Resources Development Agreement. It is used to determine program eligibility and to fulfill contractual obligations with Human Resources Skills Development Canada (Service Canada), and may be shared with Canada. The Métis Nation of Ontario may disclose such information where we are legally authorized to do so. All information collected will be kept strictly confidential and will be protected.</p><p>Client Signature Witness Signature Date </p>