The personal information requested on this form is collected under the authority of Section 33(c) of the Alberta Freedom of Information and Protection of Privacy (FOIPP) Act and will be protected under Part 2 of that Act. It will be used for registration, administrative and assessment purposes offered by ASSIST Community Services Centre.

For further information, contact the head office at:
ASSIST Community Services Centre, 9649-105A Avenue, Edmonton, Alberta, T5H 0M3; Phone: 780-429-3111; or Email: info@assistcsc.org