ERDISTON TEACHERS’ TRAINING COLLEGE PINE HILL, ST MICHAEL BARBADOS, WEST INDIES.

POSTGRADUATE DIPLOMA IN SPECIAL NEEDS EDUCATION PROGRAMME

Surname:

First Name:

Middle Name:

Gender:

Martial Status:

Date of Birth:

Country of Birth:

Nationality:

Home Address:

E-Mail Address:

Telephone Number:

Mobile Number:

Name of School/Institution where you work:

Address of School/Institution:

Telephone Number of School/Institution:

Current Teaching Assignment

List Subject(s) Taught, Level( by form) and Number of Periods per Week

Other (Please specify):

Teaching Status

Present Position:

Type of appointment

Date of Appointment to Present Position:

Professional Experience- Indicate all posts held

Please list using the following convention: Name of Post/Date/School

Academic Qualifications

Please use the following convention: Examining Body(Cambridge, London, CXC) / Subject / Year / Year Obtained / Grades

Universities Attended:

Programme(s) Followed:

Degree(s) Obtained:

Date(s):

Subjects/Courses taken for Degree(s): YEAR 1

Subjects/Courses taken for Degree(s): YEAR 2

Subjects/Courses taken for Degree(s): YEAR 3

Subjects/Courses taken for Degree(s): YEAR 4

Academic Awards:

Published/Unpublished Articles:

INSTRUCTIONS

1. Upload the following documents along with the application form:

(a) One (1) Certified copy of certificate, diplomas and degrees

(b) One (1) Certificated copy of Birth and Marriage Certificate

(d) A Medical certificate verifying applicant’s ability to pursue the programme

2. Please arrange for transcripts from Colleges or Universities to be sent to Erdiston College.

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I hereby certify that all statements on this application form are correct and complete. a) I understand that otherwise my admission to, or registration as a student of the College may be rescinded. b) I undertake to provide payment of all fees that are required. c) I will be available at the required time for classes.

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Last Name

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I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.