1. I declare, since the last Criminal Reference Check (CRC) or since the last Criminal Offence Declaration (COD) submitted to the school, that:

a. I have no convictions under the Criminal Code of Canada up to and including the date of this declaration for which a pardon has not been issued or granted under the Criminal Records Act (Canada).

b. I have no charges pending under the Criminal Code of Canada up to and including the date of this    declaration.

OR

2. I have the following convictions for offences under the Criminal Code of Canada for which a pardon under the Criminal Records Act (Canada) has not been issued or granted.

List of Offences

1)

2)

3)

(Complete additional forms if necessary)