Corozal Institute for Technical & Vocational Education & Training

Santa Rita Heights

Corozal Town
Phone: 402-0149

Enrolment Application

Note: When submitting application forms applicants must bring a copy of their Social Security Card, a
transcript or recent report card from the last school they attended, the two filled recommendations forms,
and 2 passport size pictures. A fee of $10.00 must be paid when submitting the application form.

Personal Data

Program: _____________________________________ Level: _______ Year: ______________

1. Name: __________________________ _____________________ ____________________

Surname First Middle

2. ___________________________________________ 3. Home Phone #: ________________

Address

4. Date of Birth: d/m/y: ___/___/___ Age: ____ Sex: __________ Nationality: ________________

Social Security #: _____________________________

5. Marital Status: Single/Married/Divorced/Separated/Widowed/Common-Law

6. Have you ever taken a course at ITVET before? YES/NO (b) If yes state which one: __________

7. ____________________________________ _______________________________ _____________

Mother’s Name Address Tel. #

8. ____________________________________ _______________________________ _____________

Father’s Name Address Tel. #

In case of EMERGENCY we should call:

Name: ____________________________________ Relationship: _____________________________

Phone #: _____________________________ Address: ______________________________________

Educational Background

9. Check the highest level of education that you have achieved:

Primary: _____ High School Graduate: _____ Sixth Form Graduate: _____

High School Dropout: ___________________ Other: __________________

State Form
 Corozal Institute for Technical & Vocational Education & Training
Santa Rita Heights
Corozal Town
402-0149

Medical Background

10. Do you suffer from any medical problem? YES/NO

If yes, please state: ______________________________________________________________

I understand that I am responsible for paying tuition fees as arranged with the institution. Failure to pay
fees may result in my report card and certificates being withheld.

11. What is your source of payment?

Scholarship: _____ Yourself: _____ Parents: _____ Guardian: ______

12. Person responsible for fees:

Name: ______________________________________

Address: _________________________________________________

Phone #: _______________________

I declare that the information given in this application form is truthful to the best of my knowledge, and
that any falsehood on my part could result in my dismissal. I realize that his application DOES NOT
ensure me a space at ITVET, and is only valid for twelve (12) months.

Applicant Signature: ______________________________ Date: ________________________

If the applicant is under 18 years of age, a Parent or Guardian must co-sign

Parent/Guardian Signature: _____________________________ Date: ____________________