2024 Application Form

GUYANA
MINISTRY OF EDUCATION
CYRIL POTTER COLLEGE OF EDUCATION
2024 APPLICATION FOR NEW COHORTS
Dear Potential Student:

Thank you for your interest in pursuing initial teacher education and training at our noble institution. The
Principal and staff are anxiously awaiting to welcome you. Therefore, it is with great pleasure that I take
this opportunity to encourage you to fill in all the fields on the Application Form correctly since failure
to do so may result in your being denied entry to the College.
Thank you.
Warm regards,
Principal
SECTION A: PERSONAL INFORMATION
1. NAME: (First)____________________ (Last)____________________ (Other)___________________
2. ADDRESS: ________________________________________________________________________
_____________________________________________________________ 3. REGION: ______
4. EMAIL: (Print Carefully)_____________________________________________________________
5. PHONE NUMBER: (Home)__________________________ (Mobile)_________________________
6. DATE OF BIRTH: (Day)_____ (Month)_____ (Year)_____ 7. GENDER:  Male  Female
8. MARITAL STATUS:  Married  Common Law  Divorced  Widowed  Single
SECTION B: STUDENT IDENTIFICATION
9. NATIONAL IDENTIFICATION: (No)__________________ (Date of Issue)_________________
10. NATIONAL INSURANCE: (No)__________________ (Date of Issue)_________________
11. PASSPORT: (No)__________________ (Date of Issue)_________________
12. NEXT OF KIN/EMERGENCY CONTACT:
(Full Name)____________________________________ (Relationship)_______________________
(Address)__________________________________________________________________________
__________________________________________________ (Telephone No)__________________

SECTION C: PROFESSIONAL INFORMATION
13. Are you currently employed as a teacher?  Yes  No
If YES, please provide the following information.
14. Name of Employer:  Ministry of Education  Private First Appointment: _____________

DD / MM / YYYY
15. Name of school to which you are attached: ______________________________________________
16. Subject(s) and Grade(s) currently being taught (Early Childhood and primary applicants should only
indicate Grade): ___________________________________________________________________
SECTION D: AREA OF SPECIALISATION
17. PROGRAMME:  Associate Degree in Education

 Technical Teachers’ Education
 Graduate Teachers’ Education
18. SPECIALISATION:  General Education: Early Childhood

 General Education: Primary
 General Education: Secondary Academic
 General Education: Secondary TVET
 Special Education: Early Childhood
 Special Education: Primary
 Special Education: Secondary
 Health and Family Life Education: Early Childhood
 Health and Family Life Education: Primary
 Health and Family Life Education: Secondary
 Literacy Studies: Primary
 Literacy Studies: Secondary
19. MAJOR OPTION:  Agricultural Science

 Business Studies
 English Language
 French
 Home Economics
 Industrial Technology
 Information Technology
 Mathematics
 Music
 Physical Education
 Portuguese
 Pure Sciences
 Social Studies
 Spanish
 Visual Arts
20. MINOR OPTION:  Agricultural Science
 Business Studies
 English Language
 Food and Nutrition
 French
 Home Management
 Industrial Technology
 Information Technology
 Mathematics
 Music
 Physical Education
 Portuguese
 Pure Sciences
 Social Studies
 Spanish
 Textile Studies
 Visual Arts
SECTION E: QUALIFICATIONS
21. ACADEMIC RECORD: CSEC/CXC
Subjects Grades Awaiting Results

(a) ______________________________ _______ 
(b) ______________________________ _______ 
(c) ______________________________ _______ 
(d) ______________________________ _______ 
(e) ______________________________ _______ 
(f) ______________________________ _______ 
(g) ______________________________ _______ 
(h) ______________________________ _______ 
(i) ______________________________ _______ 
(j) ______________________________ _______ 
22. ACADEMIC RECORD: POST SECONDARY
Name of Institution Period Attended Qualification

(a) _______________________ __________ _________________________
(b) _______________________ __________ _________________________
(c) _______________________ __________ _________________________
(d) _______________________ __________ _________________________
SECTION F: AGREEMENT
Upon successful completion of my programme of study, I will serve the Government of Guyana
in any Region of the country where I am needed. I will also serve for a period of at least three
years (Distance Education students) or five years (Pre-service students).
 I Agree  I Do Not Agree
Signature: …………………………….
I HEREBY CERTIFY THAT THE INFORMATION PROVIDED IS TRUE, AND IF

FOUND TO BE FALSE, I WILL BE DENIED ENTRY OR EXPELLED IF FOUND
DURING THE PROCESS OF MY STUDIES.
Signature: …………………………….
Date: ………………………………….

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GUYANA

Dear Potential Student:

SECTION A: PERSONAL INFORMATION

1. NAME: (First)____________________ (Last)____________________ (Other)___________________

4. EMAIL: (Print Carefully)_____________________________________________________________

5. PHONE NUMBER: (Home)__________________________ (Mobile)_________________________

6. DATE OF BIRTH: (Day)_____ (Month)_____ (Year)_____ 7. GENDER:  Male  Female

8. MARITAL STATUS:  Married  Common Law  Divorced  Widowed  Single

SECTION B: STUDENT IDENTIFICATION

9. NATIONAL IDENTIFICATION: (No)__________________ (Date of Issue)_________________

10. NATIONAL INSURANCE: (No)__________________ (Date of Issue)_________________

11. PASSPORT: (No)__________________ (Date of Issue)_________________

12. NEXT OF KIN/EMERGENCY CONTACT:

(Full Name)____________________________________ (Relationship)_______________________

__________________________________________________ (Telephone No)__________________

13. Are you currently employed as a teacher?  Yes  No

If YES, please provide the following information.

14. Name of Employer:  Ministry of Education  Private First Appointment: _____________

SECTION D: AREA OF SPECIALISATION

17. PROGRAMME:  Associate Degree in Education

18. SPECIALISATION:  General Education: Early Childhood

19. MAJOR OPTION:  Agricultural Science

21. ACADEMIC RECORD: CSEC/CXC

Subjects Grades Awaiting Results

22. ACADEMIC RECORD: POST SECONDARY

Name of Institution Period Attended Qualification

 I Agree  I Do Not Agree

I HEREBY CERTIFY THAT THE INFORMATION PROVIDED IS TRUE, AND IF

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1. NAME: (First)__ (Last) (Other)_

5. PHONE NUMBER: (Home)__ (Mobile)_

6. DATE OF BIRTH: (Day)___ (Month)_ (Year)___ 7. GENDER:  Male  Female

9. NATIONAL IDENTIFICATION: (No)__ (Date of Issue)_

10. NATIONAL INSURANCE: (No)__ (Date of Issue)_

11. PASSPORT: (No)__ (Date of Issue)_

(Full Name)______________ (Relationship)_

________________________________ (Telephone No)