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gistration@college-ece.ca
college-ece.ca
Application Form #1
for graduates of Ontario Colleges of Applied Arts and Technology &
Approved Post Secondary Programs in Early Ghildhood Education
General !nstructions:
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Please PRINT all information clearly. You may also download and print the Application Form and
Application Guide from the website at college-ece.ca.
Complete all sections of the Application Form. lncomplete applications cannot be processed and will
delay processlng.
Any original documents submitted may not be returned.
lf the name(s) on any of your documents are different from your current name, you must provide proof
of a name change.
The College does not accept faxed/ e-mailed copies of the Application Form.
Please mailthe original, completed, dated and signed Application Form and supporting documents,
with your applicailon and registration fee payments to:
I am an applicant in my last semester of the ECE Program otfered by an Ontario College of Applied
Arts and Technology (OCAAT) or a program on the Approved Post Secondary Programs List (see
page 5 of the Application Guide, available at college-ece.ca, for a list of OCAATs). Please answer
question 2a).
tr
tr
I am a graduate of an Ontario program on the Approved Post Secondary Programs List (see page 5
tr
of the Application Guide, available at college-ece.ca, for the Approved Post Secondary Programs
List). Please answer question 2b).
lf none of the above categories apply to you, do NOT complete this Application'Form. Please refer to the Application Guide
for lndividual Assessment Applicants or contact the College at registration@college-ece.ca for further information on the
application process.
College of Early Childhood Educators
- OCAAT
Page 1 of
Personal lnformation
Last name
First name
Siemaszko
Sylvia
Middle name(s)
Former Names
Last name at birth (if different from above)
Gender
fl
Female
Male
oo
01
*_ i1_ryvr 1991
City
I Province
Brampton
H
Postal code
A1B 3C4
lOrrl
C;A-ote)
(905) 123-4567
(905)7654321
Personal e-mail address(please include a personal e-mail address to receive communications from the College)
sylvia@sheridancollege.ca
Employment lnformation
Employment Status:
I
!
!
!
flFull-time
Part-time
Retired
Otfrer (please specify):
Current place of
cty
Province
Postal code
code) ] Current
College: B
- OCAAT
Home Address
Business Address
English
French
Page 2 of 6
i.
ii.
an applicant who is required to satisfy the requirements set out in the Registration Regulation must
provide an official transcript issued by the educational institution at which the applicant obtained his or
her academic credential, bearing the institution's seal and signature of the registrar or equivalent
officiat;
the transcript described in subparagraph (i) must be mailed directly from the educational
.
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Please refer to the Approved Post-Secondary Proqrams List on paqes 5 - 8 of the Application Guide.
2016
i.
Ontario?
ln
ii. Outside of
Ontario?
! Yes E No
! Yes E No
OR
Are you a student in your final semester of a program in early childhood education offered by a
program in Canada on the Approved Post Secondary Programs List?
! Yes E No
i.
Ontario?
ln
ii. Outside of
Ontario?
lYes ENo
I Yes l-l ltto
lf yes, please complete the following information Please anange to have an official transcript issued to the College by the educational
institution at which you obtained your academic credential, bearing the institution's seal and signature of the registrar or equivalent
official.
Note: The official transcript must indicate completion of program and must be mailed directly from the educational institution to the
College of Early Childhood Educators. For graduates of the University of Guelph's Bachelor of Science program, the transcript is
necessary to demonstrate a major in Child Studies. A letter from the Registra/s office is also requested to indicate a major in Child,
Youth and Familv - Ghild Stream.
Year Graduated
- OCAAT
Page 3 of 6
Section 3
- Language
Fluency
You must be able to speak and write in either English or French with reasonable fluency. Please check at least
one below;
[
b) !
a)
b) !
Resident card.
c) [
d) !
lam authorized under the lmmigration and Refugee Protection Act (Ganada) to engage in employment
wtthin the practice of the profession of early childhood education.
Authorization expi res : "-"-]yvAttach a photocopy of a valid work permit which provides authorization to engage in employment within the practice
of the profession.
a)
Have you ever been found guilty of a criminal offence in Canada or in any jurisdiction outside of Canada?1
lYes U No
b)
c)
d)
Have you ever been found guilty of an offence under the Controlled Drugs and Substances Act (Canada) or the
Food and Drugs Act (Canada) or any other offence relevant to your suitability to practise early childhood education?
lYes
No
Have you ever been the subject of a finding of professional misconduct, incompetence or incapacity or any other
similar finding, including a finding of professional misconduct, incompetence or incapacity made by a professional
association or other body that has self-regulatory responsibility, whether in Ontario or any other jurisdiction, in
relation to the practice of early childhood education or any other profession?
lYes ENa
Are you currently the subject of a proceeding in relation to professional misconduct, incompetence or incapacity or
any other similar proceeding, including a proceeding related to professional misconduct, incompetence or incapacity
held by a professional association or other body that has self-regulatory responsibility, whether in Ontario or any
other jurisdiction, in relation to the practice of early childhood education or any other profession?
[Yes
MNo
lf you answer "Yes" to any of tfie above questions, please provide a detailed explanation with yourapplication on a separate piece of
paper, which you may place in a sealed envelope labelled "confidential". The College will consider and assess whether the conduct is
significant. A "Yes" response does not necessarily make you ineligible for registration in the College. The College reseryes the right
to decide on an individual basis as to the possible impact of the conduct on the practice of the profession.
You are required to immediately inform the Registrar if, after having applied for but before being issued a Certificate of Registration,
you become the subject of a finding or proceeding described above or you are found guilty of an offence described above.
Note: Supporting documentation may be required such as: additional information from the Children Aid Society, letters of reference
from past or current employers, etc.
lf you have been found guilty of a criminal offence under the Youth Criminal Jusrice Acl (Canada) or the young Offenders Act (Canada), you are not required to disclose the
finding of guilty unless you received an adult sentence under the Youth Ciminal Justice Act or the matter was transfened to ordinary court undet the Young Offenders Act
- OCAAT
Page 4 of 6
Registration Fee
The registration fee amount is $150. This fee is for registration as a member and will be returned if your
application is not approved for registration. An annual fee of $150 is payable on the anniversary of the date on
which your Certificate of Registration is issued.
Please note:
. Acceptable methods of payment for fees are:
. Cheques in Canadian funds and from a Canadian bank
. Money Orders in Canadian funds and from a Canadian issuer
. Bank Drafts in Canadian funds
. Visa or MasterCard
. Post-dated cheques are not accepted.
. American Express and pre-paid credit cards are not accepted.
. Cash is not accepted and the College is not responsible for lost cash.
. A processing fee of $30 will be charged for any cheque that is not honoured.
. Bulk payments for multiple applications are not accepted.
. U.S. and other international cheques are not accepted. For international payment, please pay in
Canadian dollars by bank draft or credit card.
. lf paying by credit card, the application fee and registration fee will appear as two separate charges.
. For confidentiality and safety, the College does not accept credit card information over the phone.
. To protect the confidentiality of your information, credit card information will be blacked out after it is no
fonger needed.
Please check method of payment being submitted:
f,
Cheque/money order/bank draft for a total of $225, made out to the Gollege of Early Childhood
Educators
Cheque number;
I
!
Amount:$
Visa
MasterCard
I authorize the College of Early Childhood Educators to charge the credit card below in the amount of $225,
unless otherwise stated:
$75 onty
E $150 onty
Card Number:
1
Expiry
Date:
Month
1
Year
1
Sylvia Siemaszko
Cardholder's Signature:
- OCAAT
Page 5 of 6
I
I
original copy
An official transcript issued by the educational institution at which you obtained your academic credential,
bearing the institution's seal and signature of the registrar or equivalent official, mailed directly from the
.
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!
Studentnumber:123456789
Proof of name change(s), if applicable ( e.g. marriage certificate, change of name certificate, court order) photocopy
Proof of Citizenship/lmmigration Status (e.9. Canadian birth certiflcate, valid Canadian passport, Certificate of
Canadian citizenship, Canadian citizenship card, Certiflcate of lndian Status card, proof of Canadian
permanent resident status, valid work permit) - photocopy
Application and Registration Fee Payments (e.9. cheque, money order, bank draft or completed credit card
information)
Other Documentation: (please specify)
I understand that the College of Early Childhood Educators may make inquires to gather additional information, as
required, in connection with this application. I understand that additional information, or supporting documents,
may be required from me at a later time for further consideration of this application.
I understand that the Cottege of Earty Chitdhood Educators col[ects, uses and discloses personal information
about me for regulatory purposes in accordance with the Early Childhood Educators Act, 2007 and the regulations
and bylaws made under the Act.
I agree to notify the College of Early Childhood Educators, within 30 days, if there are any changes to the
information provided on this Application Form.
I understand that my name and class of Certificate of Registration as well as other information listed in lhe Early
Childhood Educators Act, 2OO7 and the by-laws, is information which is available to the public.
s,
18t03t16
- OCAAT
Date IDD/MM/YYYN
Page 6 of 6