Current Page 1 Page 2 Preview The Province of Prince Edward Island values diversity and encourages the participation of all Island residents on its various boards. Personal information on this form is collected under section 31(c) of the Freedom of Information and Protection of Privacy Act for program administration purposes. Questions regarding the collection or use of this information can be referred to the program coordinator at 902-620-3198 or Access and Privacy Services at 902-569-0568. Identification First Name Middle Initial Last Name Address 1 Address 2 City, Town, or Community Province Postal Code For example C1B 0X1 or 12345 Country Telephone Number For example 902-555-5555 Email Address How would you like to be contacted? - Select -EmailTelephoneText Telephone Number Cell Phone Number Email Address Applicant Information Which age group do you belong to? - Select -Under 1818-3031-5051-65Over 65 Parent/Guardian's First Name Parent/Guardian's Last Name Parent/Guardian's Telephone Number List any languages you speak and/or read in addition to English