PSW Registration Form September 2024

Thank you for your interest in the CDSBEO PSW program. Please complete the form below to register for the CDSBEO September 2024 PSW Program.

The cost of the program is covered through the Long Term Care Career Launcher Program created by the Ministry of Long Term Care in July 2023. A $250.00 deposit is required at time of registration to maintain your place in the program. The full deposit will be refunded upon successful completion of Module 1 (mid to end of October). Please note that if you submit a deposit, and do not start the program, the deposit will not be refunded. Please wait for a staff member to confirm acceptance of application prior to sending the payment.

DIRECT DEPOSIT FORM (the last page in the registration package). Our preferred method of payment is debit VISA/Mastercard payments and credit cards. You may send an e-transfer to [email protected] (Please provide your name and state "PSW deposit" in the comments) and email confirmation of transfer proof to [email protected].
You may also send an email to [email protected] to arrange a time to process payment over the phone.

Once confirmation of payment is received, your application will be reviewed for completion and you will receive an email confirming your acceptance in the program.

Please note an incomplete application form could result in you being placed on the waiting list. Required fields marked with an asterisk *

Please have the below documents ready for upload (Your application will not be finalized with missing documents)

Proof of Residency (Acceptable documents to verify address: Tenant Lease, Utility Bill, Property Tax Bill, Home Phone, Cable or Internet Bill)
High School Transcript
Direct Deposit Form and Blank Cheque

PSW Program Information

Which site are you registering for? (Please note: The program will run in that location with sufficient enrollment) IMPORTANT: Individuals living at the DEV Centre in Cornwall should speak to the educational contact to indicate an interest in the program. *

Answer Required

Contact Information

First Name*

Answer Required

Middle Name

Answer Required

Last Name*

Answer Required

Maiden Name (if applicable)

Answer Required

Gender*

Answer Required

Male

Female

Prefer not to disclose

Prefer not to specify

Date of Birth (MM/DD/YYYY)*

Answer Required

Email 1*

Answer Required

Mobile Phone*

Number Required

Home Phone

Number Required

Address

Street Address*

Answer Required

City*

Answer Required

Postal Code*

Answer Required

Proof of Residency (Acceptable documents to verify address: Tenant Lease, Utility Bill, Property Tax Bill, Home Phone, Cable or Internet Bill)*

Answer Required

Choose a file or drag it here.

Emergency Contact Information

Emergency Contact Name (First and Last)*

Answer Required

Relationship to you*

Answer Required

Emergency Contact Phone*

Answer Required

Citizenship Information

Status*

Answer Required

Canadian Citizen

Landed Immigrant

Refugee

Other Visa

Province of Birth

Answer Required

Country of Birth:*

Answer Required

Date of Entry into Canada

Answer Required

Previous School History

If you are a former student of Catholic District School Board of Eastern Ontario, which school did you last attend?

Answer Required

What was your entry date to secondary school (high school)? (Month/Year)*

Answer Required

What was the last date you attended secondary school (high school)? (month/Year)*

Answer Required

Secondary School Address

Full Name of the last Secondary (Highschool) School attended. (Please do not use abbreviations)*

Answer Required

Street Address*

Answer Required

City*

Answer Required

Province*

Answer Required

Postal Code*

Answer Required

Secondary School Transcript (Please do not upload diploma) (Please note, if your most recent transcript was issued with the Catholic District School Board of Eastern Ontario, you are not required to upload a transcript/record of achievement)

Answer Required

Choose a file or drag it here.

Have you been issued an IEP?*

Answer Required

Yes

Use of student image and information. Part of the program may consist of being photographed or videotaped. Use of students name, image and/or school work may be used in media coverage of school related events, in school or board publications, or on the school or board website/social media channels.*

Answer Required

I consent

I do not consent

I am aware there is a $250 application fee and that my application will not be completed until payment is received. I will wait for confirmation prior to sending the payment.*

Answer Required

Yes, I will send an E-Transfer to [email protected]

Yes, I will call to process a credit card payment over the phone

I am a re-entry student

Please upload your direct deposit form and void cheque here.*

Answer Required

Choose a file or drag it here.

Please fix the highlighted areas below before submitting.

PSW Registration Form September 2024