International Education Graduate Teaching Application

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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

Previous Name

If you were educated or previously certified in a name other than that used above please state the other name.

Date of Birth