Name

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Address

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Postal Code/Zip Code

Country

Phone

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Year Fellowship Conferred

English Language Skills (please select all that apply)SpeaksUnderstandsAble to Examine

French Language Skills (please select all that apply)SpeaksUnderstandsAble to Examine

Please list your experience in developing, grading, or administering examinations:

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Reference Name

Relationship

Phone Number and/or

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Reference Name

Relationship

Phone Number and/or

Email

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is committed to receiving and treating personal information in confidence. The information in this
application is collected and used by and on behalf of the College for the purpose of evaluating
the applicant’s eligibility and for any correspondence or recordkeeping necessary to manage the
volunteer’s relationship with the College. I hereby declare that all information provided in this
application is true and accurate, I authorize and consent to the College making inquiries of third
parties as are necessary to evaluate my eligibility and I acknowledge and understand that any
inaccuracy or misrepresentation will be grounds for immediate dismissal.
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