Letter of Accomplishment in Teaching English As a Second Language (TESL 1)

Apply to TESL 1

If you are a new student to the TESL 1 Program, please submit this form along with your transcripts and registration to: Student and Instructor Services, Extended Education,
185 Extended Education Complex, University of Manitoba, Winnipeg, MB R3T 2N2; by fax: 204-272-1626; or by email: extended@umanitoba.ca

STUDENT INFORMATION
Title:
*Last Name:
*First (Given) Name:
Middle Name(s):
Preferred First Name:
*Date of Birth (yyyy-mm-dd):

*Telephone Number:
*Date of Birth (yyyy-mm-dd):
Home Address:

City/Town:
Province:
Postal Code:
Day Phone:
Evening Phone:
Faculty:
*Student Number:
*Email:
*Indicates required information

Official transcripts must be submitted for the highest level of education completed. If you attend any institution subsequent to submitting this form, notify Student and Instructor Services
immediately. Trainees without a university degree will not qualify for TESL Canada Certification.

EDUCATIONAL BACKGROUND
Highest level of formal education achieved:
Date completed:
Name of educational institution:
If outside of Canada, specify city and country:
Additional employment-related training/courses completed or professional standing achieved:
Where did you first hear about this program?
Please check box if your primary language is other than English
Do you wish to provide proof of English language proficiency with your registration?

Signature:
Date:

Your personal information is being collected under the authority of The University of Manitoba Act. The information you provide will be used by the University for the purposes of registration, communication, and to facilitate payment. Your personal information will not be used or disclosed for other purposes, unless permitted by The Freedom of Information and Protection of Privacy Act (FIPPA). If you have any questions about the collection of your personal information, contact the Access & Privacy Office (tel. 204-474-9462), 233 Elizabeth Dafoe Library, University of Manitoba, Winnipeg, MB, R3T 2N2.

FULL FEES MUST ACCOMPANY THE APPLICATION

An application fee of $100 CAD will apply. The application fee is non-refundab





Card holder’s name (appears on the card):
Amount: $
Authorizing signature:
Credit card number:
Expiry date: