PSW Re-Entry Request February 2025

Re-entry to the PSW program within 2 years of initial registration.

This application is only for students who have been registered with the CDSBEO and successfully completed at least the first module within the last 2 years. A re-entry form would have been completed upon your departure.

If you do not meet this criteria, you should complete the registration form for a new student.

PSW Program Information

Who was your instructor?*

Answer Required

Re-Entry document date

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

Home Language:

Answer Required

First Language Spoken:

Answer Required

To be considered, you must have started the program after October 2022. If you started the program before this date, you do not qualify. Please go back and register as a new student.*

Answer Required

I need to complete the program starting at Module 2 (TPJ3M)

I need to complete the program starting at Module 3 (TPJ4E)

I need to complete Clinical and Consolidation (TPJ4C and TPJ4CC). I know I will need to complete a lab assessment to demonstrate retention of knowledge and skills. I may be requested to attend up to 3 classes to refresh my skills.

I need to complete Consolidation (TPJ4CC). I know I will need to complete a lab assessment to demonstrate retention of knowledge and skills. I may be requested to attend up to 3 classes to refresh my skills.

Candidates returning for Modules 2, 3 or clinical or consolidation will need an updated VSC and medical form (including 1 step TB). Please select one of the following:

Answer Required

I require a VSC letter and medical form (you will be contacted via email by PSW Instructors)

I have a medical form that was issued within the last 6 months and just require a VSC letter.

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 registration purposes and may be disclosed 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.

PSW Re-Entry Request February 2025