Current Page 1 Page 2 Preview The information collected on this form will be used for certification under the Early Learning and Child Care Act and Regulations. The information is collected under the authority of the Early Learning and Child Care Board and managed in accordance with the Freedom of Information and Protection of Privacy Act. If you have any questions about the collection, use or disclosure of your personal information, please contact the Early Learning and Child Care Board, 902-368-6513. 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 Date of Birth Previous Name If you were educated or previously certified in a name other than that used above please state the other name.