Current Page 1 Page 2 Preview Personal information on this form is collected under section 7 and 11 of the School Act R.S.P.E.I. 1988, Cap. S-2.1 and will be used for the purpose of verifying identity and salary placement purposes. If you have any questions about this collection of personal information, you may contact the Office of the Registrar, Suite 101, Holman Centre, 250 Water Street, Summerside, PE, C1N 1B6. 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, state the other name. PEI Teacher's Certificate Number PEI Teacher's Certificate Level