Mental Health Care Assistant Program English Competency Self Declaration Form

Personal Information

Legal First Name

Middle Name

Last Name

Vancouver Island University Student #

I have been educated in an English-speaking environment (in a listed country*) for seven years or more.

Yes

I have been educated in an English-speaking environment (in a listed country*) for three consecutive years at the secondary (high school) level or above.

Yes

HCA Program Entry – English Language Competency Requirements

I have read and understood the additional requirements at the link above

*Countries with English language systems / institutions (where English is a primary, official language and the language used for education)

American Samoa
Anguilla
Antigua and Barbuda
Australia
Bahamas
Barbados
Belize
Bermuda
Botswana
British Virgin Islands
Canada
Cayman Islands
Dominica
Falkland Islands
Fiji
Gambia
Ghana
Gibraltar
Grenada
Guam
Guyana
Ireland
Jamaica
Kenya
Lesotho
Liberia
Malta
Mauritius
Montserrat
New Zealand
Nigeria
Saint Helena
Saint Lucia
Saint Kitts and Nevis
Saint Vincent and the Grenadines
Seychelles
Sierra Leone
Singapore
South Africa
Tanzania
Trinidad and Tobago
Turks and Caicos Islands
Uganda
United Kingdom
United States
United States Virgin Islands
Zambia
Zimbabwe

*Applicants educated in Quebec at an institution where the language of instruction was not English, must provide evidence of external English language proficiency testing.

Please provide all details on your education history as per the example provided. (Years attended - School Name, City, Province, Country and Grades Completed / Credential Received)

Example:

1990-1998 : Jackson Elementary School, Vancouver, BC, Canada, Completed Grades K – 7
1998-2003 : Windermere High School, Vancouver, BC, Canada, Completed Grades 8 –12, Awarded High School Diploma
2003-2004 : Semiahmoo College, Surrey, BC, Canada, Completed Office Assistant Certificate Program

Electronic Signature

I am electronically signing my request. I declare that the information provided on this request is true, complete and accurate.