2027 Cyber Bootcamp Registration Form

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Applicant information

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1. Name: (Required.)

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2. Gender (Required.)

Female

Male

Other

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3. Date of Birth (MMDDYYYY) (Required.)

Date

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4. Country of Citizenship: (Required.)

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5. Passport number: (Required.)

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6. Please submit a picture of the information page (the photo page) of your Passport below (Required.)

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7. Email Address: (Required.)

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8. Phone Number: (Required.)

Academic Information

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9. Name of Home University (Required.)

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10. Please specify if you are a Bachelors, Masters, or PhD student. (Required.)

Bachelors student

Masters student

PhD student

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11. Program of Study (Required.)

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12. Current Year of Study (Required.)

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13. Please describe any background or experience you have in computer science,
programming, cybersecurity, or other related field. (Required.)

Program Selection

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14. Which Cyber Bootcamp are you applying for? (Required.)

2-week AI Module

2-week Network Module

6-week Program

Additional Information

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15. How did you hear about this program? (Required.)

Partner University

Professor or institutional contact

Social media

University of Ottawa website

Other (please specify)

Emergency Contact Information.
Please provide the contact information of the person we should contact in case of an Emergency. Please also include the relationship you have with this person next to their full
name.

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16. Contact Information (Required.)

First name

Last name

Email Address

Relationship

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17. Contact Phone Number: (Required.)

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18. Contact Address Details (Required.)

Accessibility and Health Informations

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19. Do you have any accessibility needs or medical conditions we should be aware of? (Required.)

Consent and Agreement

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20. Please check the box below to indicate your agreement. (Required.)

I confirm that the information provided is accurate to the best of my knowledge

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21. I consent to being photographed during program activities and authorize the University
of Ottawa to use these images for promotional or educational purposes, including but not
limited to publication on official websites and social media platforms. (Required.)

Yes, I consent

No, I do not consent

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22. I acknowledge that my personal information will be collected and used solely for
program registration and coordination in accordance with the University of Ottawa’s privacy
policy. (Required.)

I agree

Please contact engineering.international@uottawa.ca for any related question or inquiry.

2027 Cyber Bootcamp Registration Form

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* 1. Name: (Required.)

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* 2. Gender (Required.)

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* 3. Date of Birth (MMDDYYYY) (Required.)

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* 4. Country of Citizenship: (Required.)

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* 5. Passport number: (Required.)

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* 6. Please submit a picture of the information page (the photo page) of your Passport below (Required.)

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* 7. Email Address: (Required.)

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* 8. Phone Number: (Required.)

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* 9. Name of Home University (Required.)

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* 10. Please specify if you are a Bachelors, Masters, or PhD student. (Required.)

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* 11. Program of Study (Required.)

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* 12. Current Year of Study (Required.)

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* 13. Please describe any background or experience you have in computer science,programming, cybersecurity, or other related field. (Required.)

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* 14. Which Cyber Bootcamp are you applying for? (Required.)

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* 15. How did you hear about this program? (Required.)

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* 16. Contact Information (Required.)

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* 17. Contact Phone Number: (Required.)

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* 18. Contact Address Details (Required.)

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* 19. Do you have any accessibility needs or medical conditions we should be aware of? (Required.)

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* 20. Please check the box below to indicate your agreement. (Required.)

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* 21. I consent to being photographed during program activities and authorize the Universityof Ottawa to use these images for promotional or educational purposes, including but notlimited to publication on official websites and social media platforms. (Required.)

Question Title

* 22. I acknowledge that my personal information will be collected and used solely forprogram registration and coordination in accordance with the University of Ottawa’s privacypolicy. (Required.)

1. Name: (Required.)

2. Gender (Required.)

3. Date of Birth (MMDDYYYY) (Required.)

4. Country of Citizenship: (Required.)

5. Passport number: (Required.)

6. Please submit a picture of the information page (the photo page) of your Passport below (Required.)

7. Email Address: (Required.)

8. Phone Number: (Required.)

9. Name of Home University (Required.)

10. Please specify if you are a Bachelors, Masters, or PhD student. (Required.)

11. Program of Study (Required.)

12. Current Year of Study (Required.)

13. Please describe any background or experience you have in computer science,
programming, cybersecurity, or other related field. (Required.)

14. Which Cyber Bootcamp are you applying for? (Required.)

15. How did you hear about this program? (Required.)

16. Contact Information (Required.)

17. Contact Phone Number: (Required.)

18. Contact Address Details (Required.)

19. Do you have any accessibility needs or medical conditions we should be aware of? (Required.)

20. Please check the box below to indicate your agreement. (Required.)

21. I consent to being photographed during program activities and authorize the University
of Ottawa to use these images for promotional or educational purposes, including but not
limited to publication on official websites and social media platforms. (Required.)

22. I acknowledge that my personal information will be collected and used solely for
program registration and coordination in accordance with the University of Ottawa’s privacy
policy. (Required.)