Private college and private school sponsorship registration form

*Indicates required field

Select institution type: *

Private career college

Private school

Both

Legal name of institution: *

Operating name of institution: *

Please select which ministry the institution is registered with: *

Ministry of Colleges and Universities

Ministry of Education

Both

Ministry of Colleges and Universities registration number:

Ministry of Education registration number:

Address where education/training services delivered

Street address *

City/Town *

Province

Postal code *

Website

WSIB External Provider ID number (e.g. 100XXXXXX) *

Is the mailing address different than the address where education/training services are delivered? *

Yes

Mailing address

Street address

City/Town

Province

Postal code

Main contact (for the WSIB to share student referral information with)

First name: *

Last name: *

Job title: *

Phone number: *

Email address: *

Alternate contact

First name:

Last name:

Job title:

Phone number:

Email address:

Statement and declaration:

The training location/campus outlined on this form is registered with the Ontario Ministry of Colleges and Universities and/or the Ontario Ministry of Education
The training location/campus has a ministry registration number
I have read, understand and agree to ensure we comply with the 2024 WSIB Sponsorship Terms for Private Career Colleges and Private Schools
- If you do not already have a copy of our 2024 terms, please email us at [email protected] and we will email you a copy to review before registering with us.
I will use the WSIB online services via TELUS Health to electronically bill for services provided
I agree to contact the WSIB if any of my registration information or qualifications change
I have the authority to complete, submit and electronically sign this registration form on behalf of the institution

Signature (person submitting this form)

First name: *

Last name: *

Job title: *

Phone number: *

Email address: *

By checking this box, I am confirming and agreeing to the above statements and to the 2024 WSIB Sponsorship Terms for Private Career Colleges and Private Schools. I understand that if I do not adhere to these terms, it may result in my removal from the WSIB-approved provider listing. This represents your signature. You must fill out your contact information in the fields above. *