APPLICATION FORM

P.O. Box 282, 136-138 Henry Street, Port of Spain, Trinidad, W.I.
Telephone: (868) 627-8553/8556; Fax: (868) 623-7338
A. EDUCATION PLANS
Name of programme you wish to pursue:
Select your preferred schedule: FULL-TIME PART-TIME
B. PERSONAL INFORMATION
NAME:
HOME ADDRESS:
MAILING ADDRESS: (if different from 2)
E-MAIL ADDRESS:
TELEPHONE NOS.: Home:
Mobile:
Work:
Facsimile:
GENDER: Female Male RELIGION: DATE OF BIRTH:
MARITAL STATUS: Married Single
C. CO-CURRICULAR ACTIVITIES
Please list the co-curricular activities in which you are involved:
D. EDUCATIONAL BACKGROUND (If space below is inadequate, please continue on a separate sheet of paper.)
All applications must be accompanied by an original and one copy of all certificates. (Originals will be returned.)
Please list all Secondary Schools you have attended in chronological order:
Yes No Have you ever been required to withdraw from any post-secondary institution or college/university?
If yes, please state the name of the institution and the reason you were required to withdraw.
Year
NAME OF SCHOOL
NAME OF INSTITUTION
FROM TO
FROM TO
EXAMINATION BODY AND LEVEL
DEGREE/CREDITS EARNED
Please list all Colleges/Universities you have attended in chronological order:
/ /
DD MM YYYY
SURNAME FIRST NAME MIDDLE NAME MAIDEN NAME (IF APPLICABLE)
(a) Country of Birth/National of:
(b) Country of Residence:
National ID No.
11. Do you have a physical disability or medical condition that will continue during the period of study
If yes please specify:
1.
2.
3.
4. 5.
6. 7. 8.
9. 10.
Yes No
D. EDUCATIONAL BACKGROUND (CONT`D)
E. WORK EXPERIENCE
Please list your work history in chronological order:
Please list all Professional courses you have pursued in chronological order:
NAME OF INSTITUTION
NAME OF EMPLOYER
FROM TO
FROM TO
CERTIFICATE OBTAINED
POSITION HELD
F. OTHER INFORMATION
I first learned about ROYTEC through:
DECLARATION
I certify that all information submitted is correct and true. I understand that this application cannot be processed if it has not been fully completed and
that any misrepresentation of this data including any physical disability or medical condition may result in the denial or cancellation of admission. In
applying to ROYTEC, I understand that a code of dress for students is in effect.
I am also aware that prior to registration, I must submit a non-refundable TT$100.00 application fee.
Applicant`s Signature:
Date of Application:
SUBMISSION CHECKLIST
FOR OFFICIAL USE ONLY
Receipt Number:
Receipt Date:
Amount:
ROYTEC Representative:
Other:
1. Copies of Certificates enclosed
2. Original of Certificates enclosed
3. Photos enclosed
4. Transcripts
5. Application Fee enclosed
6. All sections fully completed
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
ROYTEC Student
Newspaper
ROYTEC Alumni
Relative
ROYTEC Representative
Other (Please specify)
Television Radio