Current Page 1 Page 2 Preview Personal information on this form is collected under section 31(c) of the Freedom of Information and Protection of Privacy Act to evaluate applicants for the Health Care Futures Program. If you have any questions about this collection of personal information, please call the Recruitment and Retention Secretariat at 902-620-3760. Identification Note: You must be returning to school in the fall and must be legally entitled to work in PEI to be eligible for the Health Care Futures Program. I certify that I will be returning to school this fall and I am legally entitled to work in PEI. 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 Alternate Contact Information First Name Last Name Telephone Number For example 902-555-5555 Email Address