GUYANA

MINISTRY OF EDUCATION
CYRIL POTTER COLLEGE OF EDUCATION
ASSOCIATE DEGREE PROGRAMME IN TECHNICAL TEACHER EDUCATION
APPLICATION 2015
SECTION A: DEMOGRAPHICS
Name (Print)
Surname First name Others

Home
Address

E-mail

Home tel No. Cell No.

Date of Birth
Date Mth Year

Region Age Gender F M

MARITAL STATUS: MARRIED [ ] COMMON LAW [ ] DIVORCED [ ] WIDOWED [ ] SINGLE [ ]

PRESENT INSTITUTION/ORGANIZATION
Name

Address

Tel: e-mail:

SECTION B: QUALIFICATIONS All listed qualifications and experiences MUST be supported with
appropriate documentations (photocopies should accompany the application form). Attach more pages if
required.

ACADEMICS
Institution/School Qualifications Grade (s) Year obtained

INDUSTRIAL EXPERIENCE (PORTFOLIOS ARE ACCEPTABLE)

Name of Organization Period Subject(s) taught Remarks

OTHER COURSE(S) ATTENDED

Name of Institution/School Period Examination Result(s) obtained Remarks
SECTION C: GENERAL INFORMATION

(a) Hobbies/Interests …………………………………………………………………………………

………………………………………………………………………………………………………

(b) Clubs/Organisations to which you belong……………………………………………………….

………………………………………………………………………………………………………

(c) Involvement in Community Activities …………………………………………………………

………………………………………………………………………………………………………

(d) Do you have a Health problem? (Specify e.g., Cardiac complaint, Diabetes, Epilepsy,
Hypertension).

………………………………………………………………………………………………………

(e) Have you ever been charged by the Police? Yes ………….. No ………………………..

If yes, give: Date …………………… Charge ……………………………………………

………………………………………………………………………………………………………

(f) Name two (2) referees who know you personally – one of whom should be the head of your
organization/ institution.

Name: ……………………………………….. Name: ……………………………………

Address: …………………………………….. Address: …………………………………

……………………………………………….. ……………………………………………

Occupation: ………………………………… Occupation: ………………………………

(g) If selected, would you like to be a resident student? ……….. If yes, Why? ………………

……………………………………………………………………………………………………

I hereby agree to serve the Government of Guyana for five (5) years (Pre-Service
Students) or three (3) years (In-Service Students), immediately after training.

Signature: ………………………………
I HEREBY CERTIFY THAT THE INFORMATION GIVEN ON THIS FORM IS TRUE.
Principals/Administrators of TVET Institutions, REdOs(Reg. #2, 3, 4, 5, 6 & 10) or the PEO
Comment: …………………………………………………………………………………………………….. Signature: …………………………………
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Date: ………………………………………
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Signature …………….. Date …………….. 2

Official use: