Wasi APPLICATION FOR ADMISSION Name: Programme Ist Choice: 2nd Choice: TRANSFORMING LIVES, TRANSFORMING COMMUNITIES TRANSFORMING THE NATION...ONE STUDENT AT A TIMEGENERAL INFORMATION ON ADMISSION PLEASE READ THIS PAGE CAREFULLY BEFORE COMPLETING THE APPLICATION 0 GENERAL MINIMUM ENTRY REQUIREMENTS Miniurn entry requirements forall programmes area follows +S CSEC (EXC) General Proficiency andior Techical Proficiency subjects inchsve of mathematics and EnglshA grades Il and i" Grade Il accepted if attained in June 1998 and beyond + ORS GCE O'Level subject inclusive of mathematics and English Language (GradesA.B or C) or equivalent Please note that standard entry requirements to certain programmes may vary according to the demands of specfe disciplines. Applcans should Consul the relevant programme brochure or contact the Admissions Ofce 138 625.5030 Ext 5900 or adrisions Qeostaate edt for further decals Applcans with advanced level subjects (eg, CAPE, GCE Levels) may be considered for advanced standing or award of ered, 2.0 QUALIFICATIONS ‘Allapplicanes must subi following forthe application tobe considered + Origa and copies of CSEC (CXC) andlor GCE O'Level certificates oF equivalenc + Ongras and copies of CAPE andlor Level certificates or equivalent + Orga and copies of birth certificate and one form of photo IO (ether identifeation card or passport) = T&T nationals ony + Onirate and copies of passport (al other pleats). PLEASE KEEP PHOTOCOPIES OF THE FORM AND ALL. SUPPORTING. DOCUMENTATION FOR YOUR RECORDS, 2.1 MATURE ENTRY Mature applicants (25 years and over) tho do not possess che minimum entry requirements and wish to be considered on the basis of experience and demonstrable competence, must submit a resume dtaling relevant ‘work and voluncary experience. 2.2 TRANSFER APPLICANTS AND ADVANCED STANDING In addon to 2.0) above, wansfer applicants must submit ofl copies of ‘rancrpt of ll subjece completed at prior tertiary lve isiton(), ‘Applicants wishing to transfer to COSTAATT with aévanced standing must sub the following along with the pplication frm + Offical transripts of all sbjecte previously completed ata tereary level + Copies of sylabus/caurse tines for courses completed +A completed Request for Transfer Credit frm, whichis avalable at the ‘Admissions Ofc, ‘The Colge evalaces the transcripts of transfer students to determine equivalency with its own programmes and requirements for graduation Please note that, depending on the programme of rey, there isa limit co the number of credits that may be transferred or the number of exemptions that may be granted. Transfer applcanes must be in good scademie standing a the previous isttlon, Please contact the Acmisions ‘Ofice for further information, 2.3 CARICOM & INTERNATIONAL APPLICANTS. In addition to (20) above, CARICOM and international applicants must submit offal copies of transcripts of all subjects completed at prior secondary and ‘erty inrétuions. these documents are notin English, 2 certiied translation fs required, It may alo be necessiry to have the ualications assessed by the Accreditation Counel of Trinidad & Tobago (ACTT) or the Curriculum Planning and Development Division (CPDD), Minisery of Education, Qualifeations supplied wil be assessed to determine equvalence to programme encry requirements. 2.4 ENGLISH LANGUAGE PROFICIENCY Appleans whose fst language is not English must provide evidence of proficiency in Englsh via an incerrationaly recognized English Language test, fuch ar the TOEFL (Test of English at a Foreign Language) or IELTS {lncernational English Language Testing System), Please see our website for ‘minimum cet scores required ‘To obtain information on TOEFL pleate vst the ETS (Edveaton Testing Serves) website at wwretsorg or email [email protected] For information on IELTS carts please vise the IELTS webuice at wowwists.org oF alernately ‘contact the nearest Brissh Counc fice for information. 3.0 PERSONAL STATEMENT/REFERENCES/OTHER Certain programmes require a personal statement, of reference, Please see number 6, page $ for further informacion. 4.0 NON-MATRICULATED APPLICANTS. Students interested in earing credit for specific college level courses without rgiserng fora fll diploma or degree programme, must sais relevant entry requirements. Such students enjoy the same privileges and responsibites as other students and ae also required to observe all calege ‘ils and regulations, including those governing student conduct. 5.0 DEADLINES FOR ADMISSION ‘Completed applications should be returned to the Admissions Office of the relevant campus (08 addrestes sted on page 6) on or prior to the publised Ceacine (eee daly newspapers and our websice) Applications eubmited afer the deadline dees may sil be considered, sbjece to sally of places. 6.0 FEES ‘Al applicants must pay aTT$25.00 non-refundable application fee to defray administrative. processing costs. There is 2 limit to the number of programmes that an appeane may apply for on single form. Additional forms wil incur a separate procesing fee. The College reserves the right to review cost forthe processing applicacons for admission at any ime. COSTAATT DATA PROTECTION POLICY By signing the declaration on &s application form de plane agrees dat the information provides can be ured inthe allowing way 1 “Toallow the College co proces your sppltin for entry + Toalow the College, a government agencybody.2 research instston cor acereng organzton to compile sass. aud o ‘alate programmer or pln fire saveation!proviin: + Toallow dhe College co exablh your student recordin manual and + Toasts the College in processing future apleation for franc ‘The Admissions Office thanks you for your interest in the College and looks forward to receiving your application. DISCLOSURE OF INFORMATION The College undertakes not to disclose the information prowded by students to any indvidinlor onacthorzed agency excep inthe ‘allowing ase: 17 The student as agreed vo such dcosure in weg: + ‘The student fae atlored information which the Colege i asked oconfm: + The student i besweon 16 and 18 andi aimed by hither parent dependant for wx purposes + The stdne finan ermergency sunton and is necessary 2 protect Inher heakh orth belt and afer of ether + The studnt i suspocte of ras asia the Coleg: +The sudenes information i equested under she laws of “Tnidaa ane Tobago by lelematelgalauthorty and means.WM costar roromensitor PLEASE COMPLETE ALL SECTIONS OF THE APPLICATION. Kindly use BLACK oF BLUE INK or TYPE and ensure thatthe form is signed and dated Applicants whe have previouty attended the college, must complete a readmission form. Applicants to programmes within the choc! of Continuing Education and Lifelong Learning SOCELL).must complete the relvant form avaiable via our website (ww.costaatt edt) PROGRAMME Please state in order of preference: Glery campus CPART-TIME 2 CHOICE CISANGRE GRANDE CAMPUS CUJANUARY SEMESTER 20 i Towaco camrus TE PERSONAL DATA -All fields in this section must be completed Surname Mailing Address (House #, Steet Name or PO. Box) First Name Gy Town Country Zip | Post Code Sa Home Phone Work Phone Mobile Phone Eat Previous Surname (any) COMALE [1] FEMALE Permanent Address (House #, Street Name or PO. Box) Ree Date of Birth {idiferen from maling address) oer Trinidad and Tobago Nat. 1D # Sia Country Zip | Post Code Passpore WomePhone—~=~*«WerkPhone—=~=~S~*SCtie Phone Zoamy of Crap Bi emercency contact Cooney of Birth Suramme ‘Addres (owe Sen Nae PO Bo tng our ave language — st Name “dares ose Scans o PO Bo No] Yes 0 Pores Ne c ‘) Ve plese sae Phone Gig Town Fat iowcion Rensonp TouneryEi ADDITIONAL INFORMATION - Please complete all fields Medical or Disability Information (De you have diab chronicong term medical condition or special need(’ «NoYes 1 tyes please complete and submic a Debilty Dtclorure Form tothe Admissions Offce, na sees envelope addressed to Director Mah and Couneeling Services, Please note eat thie information required to tsi in assezeng your requrernents for edvextoal provision NB you have not received a Diaby Disclosure Form with this appliation plese contact the Admissions Ofc, Declaration of Criminal Convictions ‘To assist n reducing risk of harm or injury to students, the College must be made aware of an applicant’ history of relevant criminal convictions. ‘Relevant’ criminal conicons ae defied a5 those of a volnt or sexual nature or those involving he supply of coneroled drugs or substances. In adltion applicants incerested in applying to sities such sr nurng alles heal sence ocal work or ay other aren volving work wit chen or wunerble aus must declare all enminal convictions. Appeants deiringa cima conviction are not automaticaly disqualified, but maybe asked to provide further information to assist inthe evaluacon of their pplication, Do you have any criminal convictions? = NoL] Yes CT yes please provide details ona separate sheet addressed ties President Student Mis in seled envelope and forward to the Admisiont Oe with tis applieion, Bi PavMenT DeTAms How do you intend to pay for your fee? (You may tek mare shan ane option) Se) GAEL] Sponsor] Ifyou aeilbe in receipt of sponsorship. plas provide che name ofthe individual organisation instution andthe adres celephone number(s andor email contacts) Name of OgaizatonTosteton Prone inal ms Bi acapemic RECORD SECONDARY EDUCATION Please encr all subjecs you have stucied andthe results receive you are currently sing and aang results, please wricpending’in the result column and the ‘expected dae inthe relevan colurnf necessry, you may continue on separate sheet. scHooL AWARDING BODY SUBJECTS. RESULTS YEAR AWARDED (o4 €X6,cAMNIDGE we) DATE EXPECTED POST-SECONDARY QUALIFICATIONS & TRAINING (DIPLOMAS, CERTIFICATES, DEGREES) Trarfer Seder completing Gis ston must soppy trerariptsofALL subjects completed wt your pio tertiary ld nation INSTITUTION [AWARDING BODY" ‘QUALIFICATION RESULTS, YEAR AWARDED upto sare EXPECTED ‘For example: CIM - Chartered Institute of Marketing | ABE ~ Association of Business Executives (Use NIA (not applicable) ifthe awarding body ia university or college,[PERSONAL STATEMENT/REFERENCES/OTHER SUPPORTING DOCUMENTS a ka ‘Medical Laboratory Technology (AAS, BSc) Enviconmental Health (AAS, 8Se) SA88 Occupational Safety and Health (AAS, BSc) Social Work (BSW) Eatly Childhood Care and Education (8A) SSN 8 8 ‘These should address academic background, relevant work or voluntary experience, expectations ofthe programme, and career goals (if any). The statement should be submiteed on a separate sheet and must not exceed 350 words, Additionally, applicants to the Advanced Diploma in Medical Ultrasound must also state research and professional development goals. Eawork exrerience Please give details of your currentlmost recent pad or voluntary employment (you may tick more than one box). Please continue on a separate sheet necessary. Employment san UTEP —CLmployd © Fultine © Pareine | Aroyou curently enplyed at COSTAATT? CO serenpoyes Yee CINo yep provid our SID No DURATION EMPLOYER PosiTiON DESCRIPTION OF MAIN DUTIES mon | 70 (AME AND ADDRESS) Emarketine pata How did you FIRST learn about the programmes/courses offere 3y COSTAATT? (Please tick only one) Personal Contact Print/Broadeast Media InternetSocial Media 1 ColleaguerWork Newslaters | Television 1 COSTAATT Website Former/Curren Sudent of COSTAATT. 1 Newspapers | Radio 1 Other Website 1 FriendtFamity t Magssine 1 Facebook TeacherlSchool/College Telephone Drectoryellow Pages t esegram (Other (lease state)Eibectararion oF APPLICANT ase read carefully before signing. Applicants under 18 years of age require the signature of a parent or guardian. | certify that all information contained in this application is true to the best of my knowledge. | agree to abide by the rules and regulations of COSTAATT. | understand that falsifying any part of this application may result in rejection of the application or termination of my registration with the institution, Signature of Applicant Date FOR APPLICANTS UNDER 18 Name of Parent/Guardian (First Name/Surname) Relationship Mobile # Email Signature of Parent/Guardian Date NOTE: THIS APPLICATION IS NOT CONSIDERED COMPLETE UNTIL THIS DECLARATION HAS BEEN SIGNED AND DATED. ID arpuicant CHECKLIST ‘To avold delaying the processing of your application, 5® ensure you have submitted the followin LD. Orgas and photocopies of relswane academic certificates C1 Orgnals and photocopies of birth ceriate together wih pssport or Trndad and Tobago naonal 1D (Trinidad and Tobago Nat Onna! ane photocopy of pusssore (CARICOM and international applicants) [1 T7525.00nom-efundsleappleation fee (cath bank drat eee or debit cars) [Two writen character references “+ General Nursing + Psychiatrie Nursing + Midwifery + Medical Labortory Technology + Environmental Health + Occupational Safety and Health + Radiography = Social Work Personal saement + BSc Raclography * Advanced Diploma Medical Ukrasound Paice Cerefente of Character + General Nursing + Paychiatrie Nursing + Midwifery + Early Childhood Care and Educston Nursing Counel Permit 1 Ganeral Nursing «Psychiatric Nursing * Midwifery NOTE: APPLICATIONS FORWARDED IN THE MAIL MUST BE ACCOMPANIED BY COPIES OF QUALIFICATIONS AND IDENTIFICATION. APPLICANTS MUST PRESENT ORIGINALS DIRECTLY TO THE ADMISSIONS OFFICE NO LATER THAN TWO WEEKS AFTER SUBMISSION OF THE APPLICATION. APPLICATIONS WILL NOT BE PROCESSED UNTIL ALL RELEVANT DOCUMENTATION HAS BEEN RECEIVED. ‘COMPLETED APPLICATION FORMS SHOULD BE SUBMITTED TO ANY OF THE FOLLOWIN 1. ACADEMY OF NURSING AND 2. CHAGUANAS CAMPUS 3. CITY CAMPUS ALLIED HEALTH, EL DORADO Pierre Road Connector 9-11 Movie Lane ‘Commer College and St, Cecelia Roads, CChaguanas Port of Spain| Ei Dorado “Tel (868) 625-5030 exe 5243/5246 Tel (868) 625-5030 ext 5900 “Tel (868) 625-5020 exe 5800/5814 4. SANGRE GRANDE CAMPUS 5. SOUTH CAMPUS 6. TOBAGO CAMPUS 121 Eastern Main Road, 40-44 Sutton Street Glen Road #1 Wikon Road Sangre Grande San Fernando Searborough Tobago Tek (868) 625-5030 ext 5650 Tel (868) 625-5030 exe 5776157825783 “Tek (868) 625 5030 ext 5600[I PROGRAMME LISTING SCHOOL OF NURSING, HEALTH AND ENVIRONMENTAL SCIENCES pees bs FullTime ParecTime |e Enveonmentl Stier AAS Geograph nfrmaton ites moo ‘As ocupaonal Safety & Heal moo woe SCHOOL OF LIBERAL ARTS AND HUMAN SERVICES [Far Choad Care and Eduation wo Criminal sie and _-8ACrimina sce: Police Slence 7 roo eee mon : CAMPUS KEY: + Academy of Nursing an Allied Health, CL Dorado CE + Chaguanas Compus CH + Tobago Compus CF + North Learning Centre NC + Giy Campus Cc 1 Sonate Grande campus C6 + South campus[IB ProGRAMME LISTING CON’T SCHOOL OF BUSINESS AND INFORMATION TECHNOLOGIES Pore De a BA Management and Entrepreneur mov ‘ ‘information Technology - norman Sates Development fn nm ov 2S infomation Technolog - Operate Sates Managemen fn mov vy ev ‘As brary and ifrmaton ties fv nm ov KEN GORDON SCHOOL OF JOURNALISM AND COMMUNICATION STUDIES Pore peas iS 05 uralen Pa Reltons “ ‘ “ CAMPUS KEY: + Academy of Nursing and Aled Heath EL Dorado CE + chaguanas Campus CH + North Leaning Centre NC + ary campus ec + sangre Grande Campus CS + South campus ¢5 + Tobago Campus Cr COSTAATT RESERVES THE RIGHT TO CANCEL OR MODIFY ANY PROGRAMME ADVERTISED. 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