CTC – Rev. 2008

DIOCESE OF JAMAICA & THE CAYMAN ISLANDS

CHURCH TEACHERS’ COLLEGE: MANDEVILLE

APPLICATION FORM

(To be completed and returned to the College) PERSONAL INFORMATION

PHOTO Please paste a passport

size picture here

Place the other in an envelope and submit

with Application Form

SURNAME: ___________________________________________ (PLEASE USE BLOCK LETTERS) CHRISTIAN NAME: _____________________________

MIDDLE NAME: ________________________________

MAIDEN NAME: ________________________________

GENDER: Male Female

MARITAL STATUS: _____________________________

DATE OF BIRTH: _______________________________

NATIONALITY: _________________________________

HOME ADDRESS

Street/District: ___________________________________________________________

City/Parish:______________________________________________________________

Country: _____________________ Email Address: ______________________________

Contact Nos.:: Mobile________________ Home:____________ Work:____________

POSTAL ADDRESS (if different from Home address) Street/District: __________________________________________________________

City/Parish: ____________________________________________________________

Country: _____________________

EMERGENCY CONTACT Name: ______________________________ Relation to you:___________________ Address: ______________________________________________________________

Contact Nos: Home: __________________ Mobile: ________________________

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REVISED

PROGRAMME CHOICE Please tick the Diploma Programme that you wish to pursue:

EARLY CHILDHOOD (Fulltime)

EARLY CHILDHOOD (Part-time)

SECONDARY EDUCATION SPANISH (Primary)

If you select the Secondary Education Programme, state, in order of preference, the Subject Options you wish to pursue. (See Page 7): 1. _______________________________________________________ 2. _______________________________________________ If given the opportunity to upgrade to degree status, would you be interested? Yes No

EDUCATION INSTITUTIONS ATTENDED

School Name / Type Street or District

City or Parish Country Date

From Date

To

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REVISED QUALIFICATIONS (Subjects passed and Certificates awarded)

Status (obtained/pending)

Examining Body Subject Area Grades Date

ACTIVITIES

Offices held: ___________________________________________________________________ Games played: _________________________________________________________________ Hobbies: ______________________________________________________________________ Clubs: ________________________________________________________________________ Responsibilities/duties: __________________________________________________________ _____________________________________________________________________________ Do you play a musical instrument? Yes No If yes, please state: _____________________________________________

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REVISED

REFERENCES Please give three (3) character &/or job references

1. NAME: __________________________________________________________________

ADDRESS:________________________________________________________________ PHONE NO: _____________________________

2. NAME: __________________________________________________________________ ADDRESS: _______________________________________________________________ PHONE NO: _____________________________

3. NAME: __________________________________________________________________

ADDRESS: _______________________________________________________________ PHONE NO: _____________________________

FINANCIAL INFORMATION Indicate how you will finance the programme for a three year period: _____________________ ___________________________________________________________________ ___________________________________________________________________

JOB HISTORY

Have you ever had any teaching experience? Yes No If Yes, state total years of teaching experience ____________ If you have left school, have you been working since leaving? Yes No If Yes, please list your employment in the Table below:

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REVISED

JOB HISTORY TABLE

Employer/Position Street/ District Parish/city Country From To

If no, what have you been doing? ___________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________

COLLEGE

COLLEGE PREFERENCES: Choice 1: ______________________________________________ Choice 2: ______________________________________________ Choice 3: ______________________________________________

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REVISED Would you accept an offer from another College? Yes No Do you need accommodation on Campus? Yes No List two (2) Persons you can stay with if accommodation on Campus is not offered: 1. Name: __________________________________________________________________

Address: ________________________________________________________________

Phone no: _______________

2. Name: __________________________________________________________________

Address: ________________________________________________________________

Phone no: _______________

Are you willing to comply with the College’s

Dress code? Yes No Deportment regulations? Yes No General rules & regulations? Yes No

CONFIDENTIAL

Parents’ Name:________________________________________________________________ Parents’ Address:______________________________________________________________ Parents’ Contact Nos:__________(Cell) ____________(Home) _____________ (Work) Spouse’s Name (if applicable)____________________________________________________ Spouse’s Address (if applicable):__________________________________________________ Spouse’s Contact Nos. (if applicable): ___________ (Cell) ____________ (Work)

Religious Affiliation/Denomination:________________________________________________

Does your religion prevent participation in any of the following activities?

Physical Education: Yes No Music and Movement: Yes No Chapel Service: Yes No Daily College Worship: Yes No Christmas Lunch: Yes No Graduation: Yes No If YES, please explain:__________________________________________________________ ____________________________________________________________________________

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REVISED CHURCH TEACHERS' COLLEGE: MANDEVILLE

Secondary Education SUBJECT OPTIONS OFFERED – 2008

Students must have a CXC (or equivalent) Grade 1 or 2 in the subject area.

Double Option Programmes

English (Language and Literature) Science (Chemistry, Physics or Biology- choose any two) Human Ecology (Home Economics) Mathematics

Single Option Programmes Students MUST pursue subjects in ONE of the following combinations:

Religious Education and History Religious Education and Mathematics Religious Education and Social Studies Religious Education and Geography Religious Education and Computer Studies Science and History Science and Mathematics Science and Geography Science and Computer Studies Physical Education and Mathematics Physical Education and Science Physical Education and History Computer Studies and History Computer Studies and Social Studies Computer Studies and Mathematics History and Geography Geography and Social Studies Geography and Mathematics