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 Office of the Registrar, Certification and Standards Section, Holman Centre Suite 101, 250 Water Street, Summerside, PEI C1N 1B6 Telephone 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 please state the other name.