PSW Student Intake Form – Trillium Vocational Institute

TRILLIUM VOCATIONAL INSTITUTE PERSONAL SUPPORT WORKER PROGRAM STUDENT INTAKE FORM

* Indicates required question

Email*

Phone Number*

First Name*

Middle Name

Last Name*

Date of Birth*

Country of Citizenship*

Current Status in Canada*

Have you completed OSSD? Ontario Secondary School Diploma or an equivalent?*

If English is not your first language, you must provide proof of English competency.*
English Language Proficiency Requirements are:
• IELTS – Int’l English Language Testing Services – Minimum score of 6.0 with no subject test score lower than 5.5 or
• TOEFL – Test of English as a Foreign Language Internet based test (IBT) – Overall 80 with the minimum in each component: Reading 20, Listening 20, Speaking 20, Writing 20 or
• CAEL: Overall 60 with No section below 60

Do you have a Signed Vulnerable Sector Disclaimer?*

Do you have a Signed Medical Disclaimer?*

Interested Program*

Referral Resources*

Name of the Agent (Only if Applicable)

CONSENT

PRIVACY

By providing us with any required registration and/or personal information, you agree that we may perform verification and screening services and will hold your information in accordance with our privacy policy and data governance practices as a data controller.

STUDENT CONSENT

You allow us to share their information with our institutional partners and organizations and authorize Trillium Connects to deal with our partners on your behalf.

I agree*

CONSENT

PRIVACY

STUDENT CONSENT

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