FORM E-001 St. Paul's Empowerment Education Program Registration Please use this form to provide your information and register for the St. Paul’s Empowerment Education Program. This helps ensure your enrollment and course selection are properly processed. NAME OF STUDENT DATE OF BIRTH ADDRESS SELECT YOU CONSTITUENCY St. George — Algernon Watts St. John’s City East — Melford Nicholas St. John’s City South — Steadroy Benjamin St. John’s City West — Gaston Browne St. John’s Rural East — Maria Browne St. John’s Rural North — Charles Fernandez St. John’s Rural South — Daryll Matthew St. Peter — Rawdon Turner St. Philip North — Randy Baltimore St. Philip South — Kelvin Simon St. Mary’s North — Anthony Smith Jr. Mary’s South — Kelvin ‘Shugy’ Simon St. Mary’s North East — Richard Lewis All Saints East & St. Luke — Jamale Pringle All Saints West — Anthony Smith St. Paul — E. P. Chet Greene Barbuda — Trevor Walker EMAIL TELEPHONE EMPLOYER JOB DESCRIPTION SELECT YOU EDUCATION STAGE Primary Secondary Tertiary ARE YOU A REGISTERED VOTER Yes NO SELECT THE BOX NEXT TO THE STATEMENT THAT APPLIES TO YOU. I am a 5th Form Student preparing for CXC exam. I am an adult preparing for CXC exam. I am an adult who wants to enhance my knowledge SELECT THE COURSE(S) YOU WOULD LIKE TO TAKE. Mathematics English A Social Studies Physical Education Spanish Mandarin (Chinese) I HEREBY DECLARE that the information provided in this registration form is true, complete, and accurate to the best of my knowledge. I UNDERSTAND that submission of this form constitutes a request to register for the St. Paul’s Empowerment Education Program and does not guarantee placement, which is subject to review and availability. I CONSENT to being contacted by the St. Paul Constituency Office regarding my registration, program updates, scheduling, and related opportunities via telephone, email, SMS, or other communication methods provided. I AGREE to receive notifications, alerts, and relevant updates pertaining to the St. Paul’s Empowerment Education Program and related initiatives. I UNDERSTAND that I may opt out of non-essential communications at any time in accordance with applicable policies. I confirm that I have read, understood, and agree to the above terms and conditions. Send
