Cornwall Waitlist -PSW Registration- September 2025

DISCLAIMER: Completion of this form does not guarantee you a place in the September 2025 program or any future program.

Thank you for applying to the CDSBEO PSW program. Please complete the form below to complete Step 2 of the Application for registration to the CDSBEO September 2025 PSW Program. There is some duplication in the information requested to ensure we have the most up-to-date information on file.

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.

Required fields marked with an asterisk *

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

Completed Medical Forms (CDSBEO forms, last 2 pages of the registration package)
High School Transcript

Application number provided in an email to you by PSW Administration*

Answer required for "Application number provided in an email to you by PSW Administration"

If your preferred class site is full are you willing to travel to an alternate site if available?*

Answer required for "If your preferred class site is full are you willing to travel to an alternate site if available?"

Yes

If yes, what other site would you like to be considered for?

Answer required for "If yes, what other site would you like to be considered for?"

Contact Information

Legal First Name*

First name on your legal documents

Answer required for "Legal First Name"

Preferred First Name*

Name you wish to be called

Answer required for "Preferred First Name"

Middle Name

Answer required for "Middle Name"

Last Name*

Answer required for "Last Name"

Maiden Name (if applicable)

Answer required for "Maiden Name (if applicable)"

Gender*

Answer required for "Gender"

Male

Female

Prefer not to disclose

Prefer not to specify

Date of Birth (MM/DD/YYYY)*

Answer required for "Date of Birth (MM/DD/YYYY)"

Email 1*

Answer required for "Email 1"

Mobile Phone*

Number Required

Home Phone

Number Required

Address

Street Address*

Answer required for "Street Address"

Unit or Apartment number if applicable

Answer required for "Unit or Apartment number if applicable"

City*

Answer required for "City"

Postal Code*

Answer required for "Postal Code"

Previous School History

Have you ever attended an ELEMENTARY or SECONDARY school in ONTARIO?*

Answer required for "Have you ever attended an ELEMENTARY or SECONDARY school in ONTARIO?"

Yes

Are you a former Elementary or Secondary student of the Catholic District School Board of Eastern Ontario?*

Answer required for "Are you a former Elementary or Secondary student of the Catholic District School Board of Eastern Ontario?"

Yes

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

Answer required for "If you are a former student of Catholic District School Eastern Ontario, which school did you last attend?"

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

Answer required for "What was your entry date to secondary school (high school)? (Month/Year)"

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

Answer required for "What was the last date you attended secondary school (high school)? (Month/Year)"

Secondary School Address

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

Answer required for "Full Name of the last Secondary (Highschool) School attended. (Please do not use abbreviations)"

Street Address*

Answer required for "Street Address"

City*

Answer required for "City"

Province*

Answer required for "Province"

Postal Code*

Answer required for "Postal Code"

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 for "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)"

Choose a file or drag it here.

Are you looking to obtain your OSSD?*

Answer required for "Are you looking to obtain your OSSD?"

Yes

Have you been issued an IEP?*

Answer required for "Have you been issued an IEP?"

Yes

Completed and signed Medical Forms (CDSBEO forms, last 2 pages of the registration package)*

Answer required for "Completed and signed Medical Forms (CDSBEO forms, last 2 pages of the registration package)"

Choose a file or drag it here.

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 for "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."

I consent

I do not consent

Email confirmation*

Answer required for "Email confirmation"

The Catholic District School Board of Eastern Ontario collects personal information under the authority of the Education Act and the Municipal Freedom of Information and Protection of Privacy Act (MFIPPA), for the purpose of the administration of educational programs and services within CDSBEO. All information is collected in compliance with legal and regulatory requirements. The information will be used for administrative purposes and may be disclosed to as required by law. We implement important measures to protect your information from unauthorized access, use, or disclosure. You have the right to access and correct your personal information held by us. For questions about this collection, please contact the CDSBEO Privacy Officer at [email protected],

Please fix the highlighted areas below before submitting.

Cornwall Waitlist -PSW Registration- September 2025