Students Must: Proof Obtained?
Be enrolled as a full-time student at a post-secondary education institution
Be a Canadian citizen, permanent resident, or persons to whom refugee protection has been conferred
Be legally entitled to work in Canada in accordance with relevant provincial or territorial legislation and regulations
Be studying in fields related to science, technology, engineering, mathematics, and/or business

PART 1: Student Information


PART 2: Information On Under-Represented Groups

Woman in Stem:
Indigenous Student:
Student with Disabilities:


Recent Immigrant:

First-Year Student:


PART 3: Program Information

Student Status:
Name of PSE Program:
Type of Degree:


Year of Study:
Name of PSE Institution:
Type of PSE Institution:

PART 4: Placement Information

Type of WIL Opportunity:



Taking Place in Which Semester:
System Used To Find The Opportunity:

Level of Quality of The Opportunity:
Aligned with PSE programOffers the student adequate exposure to workHelped develop entrepreneurial mindset, foundational and/or work-ready skills

I, [name of participant] the undersigned, give my consent for Information Technology Association of Canada Talent Division to release the information contained in this form regarding my participation in the Student Work Integrated Learning Program (SWILP) to Employment and Social Development Canada (ESDC). I acknowledge that the information is collected and administered in accordance with the Department of Employment and Social Development Act, Privacy Act and applicable laws, and that it may be used to determine my eligibility for SWILP and provided to ESDC for the evaluation and accountability of the SWILP.

Sign below: