EDUCATION

Name of Secondary / Tertiary Schools attended From Subject GradeTo

NATIONAL SKILLS DEVELOPMENT PROGRAMMEJOURNEYMAN PROGRAMME- 3 years

APPLICATION FOR ADMISSIONENTRY REQUIREMENTS:• Between the age of 17-25 years• Must possess at least three CSEC

or GCE passes (1,2,3 or A,B,C respectively) including Mathematics, English, any of the Sciences, Technical Drawing, Mechanical Engineering Technology, Electrical/Electronic Technology.

• National Examination Council (NEC) Craftsman Certificate or the Pre-Technician Certificate in the relevant area.

* Preference will be given to applicants with both NEC Certification and Requirement above.

• Must be a National/Resident of Trinidad and Tobago.

• Copy of Electronic Birth Certificate• Copy of Identification Card• Utility Bill• Two passport sized photos• NIS number

Sex: Male Female Marital Status

I.D. or Passport No:

Date of Birth

Place of Birth

Nationality

DAY MONTH YEARAge

Address

Mailing Address (if different)

Tel. No. (Home) (Cell)

Email

Student #:

PLEASE ATTACHPASSPORT SIZE

PICTURE

Surname

First Name

Other Name

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Visit us @ www.mic.co.tt

Rev

: Mar

.201

9

Upon successful completion of HYPE Electrical / WeldingSubject to recommendation and Interviews.

Date

Date

DECLARATION OF APPLICANT

Signature of Applicant

For further information contact the Training Department Phone no.: 1 (868) 663 - 4642 - ext 3128, 3217 Email: training@mic.co.tt

PLEASE READ CAREFULLY BEFORE SIGNING

THIS COLUMN IS FOR OFFICIAL USE ONLY

Registration Number:

Date of Notification:

Date of Admittance:

Accepted:Yes ( ) No ( )

WORK EXPERIENCEName of Employer Post held From To Reason for Leaving

Hobbies and Community Involvement:

How did you learn about this course? Radio T.V. Press Event

PromotionSocial Media Ex-Trainee Community Outreach

Other ______________________

Self Parent/Guardian Company

Acknowledgement Date:

Entrance Test Result:

Interview Results:Tuition Fees will be covered by G.A.T.E.

Should you refuse G.A.T.E. Please indicate how your tution fees will be paid:

Signature Signature

FINANCIAL ARRANGEMENTS

Parent/Guardian Authorised Co. Representative/Stamp

I certify that all information contained in this application is true and correct to the best of my knowledge. I agree to abide by the rules and regulations of MIC-IT. I understand that falsifying any part of this application may result in rejection of the application or termination of my registration with the institution.

SUBMIT THIS APPLICATION FORM

AT ANY OF THE FOLLOWING

TRAINING CENTRES

PLEASE INDICATE YOUR PREFERRED CENTRE LOCATION: (tick the approprate box)PLEASANTVILLE TECHNOLOGY CENTRECircular Rd. Pleasantville1 (868) 657-6047

LAVENTILLE TECHNOLOGY CENTREEastern Main Road, Laventille1 (868) 625-1240 / 1076

TOBAGO TECHNOLOGY CENTRE143 Milford RoadCanaan, Tobago1 (868) 631-1300

MACOYA HEAD OFFICE5A Century DriveTrincity Business ParkMacoya1 (868) 663-4642

NOTE: THIS APPLICATION IS NOT CONSIDERED COMPLETE UNTILTHIS DECLARATION HAS BEEN SIGNED AND DATED.

If under the age of 18, signature of Parent or Guardian

Name Relationship

Address

Tel. No. (Home) (Cell) Email

EMERGENCY CONTACT (Parent, Guardian or Next of Kin)

(Please make cheques payable to MIC Institute of Technology Limited)