Current Page 1 Page 2 Preview Personal information on this form is collected under sections 98 and 100 of the Education Act R.S.P.E.I. 1988, Cap. E-.02 and will be used for the purpose of verifying identity and educational credentials. If you have any questions about this collection of personal information, you may contact the Registrar's Office at 902-438-4130. 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