"Record of on-Going Training Hours - Renewal Form for Re-certification" - Prince Edward Island, Canada

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RECORD OF ON-GOING TRAINING HOURS -
RENEWAL FORM FOR RE-CERTIFICATION
This form is to be COMPLETED IN FULL & is REQUIRED to be returned to the
Department of Education & Lifelong Learning with an Authorized signature for training attended.
Please attach copies of your workshop/course certificates as proof of
training.
Name: _________________________________
Expiry date of Certificate: __________________
Address: _______________________________
Level of Certification:
_______________________________________
Early Childhood Educator I
_______________________________________
Early Childhood Educator II
Phone: _________________________________
Early Childhood Educator III
Email: __________________________________
Early Childhood Educator Supervisor
Early Childhood Educator Director
Place of Employment:
________________________________________
Criminal Record Check & Vulnerable Sector Search
Phone number of place of employment:
Completed & attached
* Please advise our office if you have
submitted a CRC or VSS in the past
________________________________________
3 years from the application date.
I declare that all information given on this application is true, correct and complete to the best of my knowledge and I
hereby authorize the Registrar to the Early Learning and Child Care Board to verify the above information.
SIGNATURE: _______________________________________________________________________________________
NAME OF WORKSHOP
(MUST BE COMPLETED)
DAY / MONTH /
# OF
AUTHORIZED SIGNATURE
Professional Dev. Section here
YEAR
HOURS
IN SERVICE: (Maximum
DAY / MONTH /
# OF
AUTHORIZED SIGNATURE
10 hours in 3 years)
YEAR
HOURS
Please return this form to the:
Early Childhood and Child Care Board
c/o Department of Education & Lifelong Learning
3 Brighton Road, P.O. Box 2000, Charlottetown, PE C1A 7N8 ; Phone: 902-368-6513 ; Fax: 902-569-7532
RECORD OF ON-GOING TRAINING HOURS -
RENEWAL FORM FOR RE-CERTIFICATION
This form is to be COMPLETED IN FULL & is REQUIRED to be returned to the
Department of Education & Lifelong Learning with an Authorized signature for training attended.
Please attach copies of your workshop/course certificates as proof of
training.
Name: _________________________________
Expiry date of Certificate: __________________
Address: _______________________________
Level of Certification:
_______________________________________
Early Childhood Educator I
_______________________________________
Early Childhood Educator II
Phone: _________________________________
Early Childhood Educator III
Email: __________________________________
Early Childhood Educator Supervisor
Early Childhood Educator Director
Place of Employment:
________________________________________
Criminal Record Check & Vulnerable Sector Search
Phone number of place of employment:
Completed & attached
* Please advise our office if you have
submitted a CRC or VSS in the past
________________________________________
3 years from the application date.
I declare that all information given on this application is true, correct and complete to the best of my knowledge and I
hereby authorize the Registrar to the Early Learning and Child Care Board to verify the above information.
SIGNATURE: _______________________________________________________________________________________
NAME OF WORKSHOP
(MUST BE COMPLETED)
DAY / MONTH /
# OF
AUTHORIZED SIGNATURE
Professional Dev. Section here
YEAR
HOURS
IN SERVICE: (Maximum
DAY / MONTH /
# OF
AUTHORIZED SIGNATURE
10 hours in 3 years)
YEAR
HOURS
Please return this form to the:
Early Childhood and Child Care Board
c/o Department of Education & Lifelong Learning
3 Brighton Road, P.O. Box 2000, Charlottetown, PE C1A 7N8 ; Phone: 902-368-6513 ; Fax: 902-569-7532