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UNIVERSITY OF PRINCE EDWARD ISLAND

CLLL CCRS - Application for Registration - Certificate Program in Conflict Resolution Studies

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Certificate Program:

I wish to apply for the Certificate Program in Conflict Resolution Studies.

Please submit this application online, or print pdf format application and forward it to:
Certificate Program in Conflict Resolution Studies
Centre for Life-Long Learning
550 University Ave
Charlottetown, PE, C1A 4P3 Canada
902-566-0336 or 1-877- 440-2277(CCRS) FAX - 902-566-0451

1. Participant Information

(All fields in this section are required)

Last or Family Name: *

First Name: *

Street Address: *

Town / City: *

Province: *

Postal Code: *

Home Phone (including area code): *

Fax Number:

Email Address: *

Name of Company / Organization:

Title / Position with Company:

Street Address/Box # of Company:

City / Town:

Province:

Postal Code:

Have you ever taken a UPEI Course?

If Yes, UPEI Student ID#:

If No, Date Of Birth: *

2. Formal Education

Institution 1:

From:

To:

Academic Credentials:

Certificate(s)

Diploma(s)

Degree(s)

Specify:

Major Field(s):

Institution 2:

From:

To:

Academic Credentials:

Certificate(s)

Diploma(s)

Degree(s)

Specify:

Major Field(s):

Institution 3:

From:

To:

Academic Credentials:

Certificate(s)

Diploma(s)

Degree(s)

Specify:

Major Field(s):

3. Additional Training

Conflict Resolution Training or Directly Related Training Completed.
(If seeking credit, forward copy of course description and proof of completion)

Date - Course Title - Instructor - Organization Offering the Course - Number of Hours:

4. Objectives

Why are you taking these courses?:

Personal Interest/ Growth

Professional Improvement / Skills

Professional Change

Certificate / Accreditation

5. Promotion

The CCRS would like to keep you updated on the latest news, events and courses at the Centre.

Would you like to be included on our mailing list?: *

Course Updates(Monthly)

News and Events (Quarterly)

No, Please do not add me

Your privacy is important to us. See our privacy policy at: UPEI Personal Information & Privacy Policy

6. Fees

Tuition Fees will vary depending on the costs of each course and number of hours. Certificate registrants will have priority for seats.

Full course registration payment is due in advance to complete the registration process.

Please forward all payment inquires to our UPEI Accounting office at 902-566-0316 or jlallen@upei.ca

Who will pay your tuition fees?: *

Your Employer

Self

Both

$50.00 for Admission:

check to indicate that fee of $50.00 for Admission is being forwarded. All cheques are payable to the University of Prince Edward Island and application fees are non-refundable.

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University of Prince Edward Island, 550 University Avenue, Charlottetown, PE, Canada C1A 4P3 |