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Personal Details

Title

First Name

Surname

Birth Date

Age

Nationality

Gender

Male

Female

Marital status

Married

Single

Divorced

Common law

Widowed

Personal Identification
Please provide any two (2) valid forms of identification

Birth Certificate Pin

Birth Certificate (photo)

National ID No

National Id (photo)

Driver’s Permit No

Drivers Permit

Passport No

Personal Passport Size Photo (white background only)

Contact Information

Address

Phone (landline)

Phone (mobile)

Emergency Contact

Name

Telephone Contacts

Relationship

Education

Secondary Education

Name of School	Examining Body	Subject	Grade	Year Awarded	Attachment File

Post Secondary Qualification and Training

Institution	Programme	Period of Attendance		Grade	Certificate

Employment Information

Are you currently employed?

Yes

Are you self-employed?

Yes

Programme Entry Routes

Academic Route

Persons who are age eighteen (18) or over, possess the standard five (5) CSEC passes –Mathematics, English A, two (2) science subjects and one (1) other subject.

Persons who are age eighteen (18) or over, possess two (2) CSEC passes Mathematics and English A, and a minimum of two (2) years’ experience in the field of endeavour, or in the allied medical/ health industry.

Persons who are age eighteen (18) or over, and possess any combination of five (5) CSEC passes.

Mature Entry Route

Persons who are age eighteen (18) or over, possess less than the standard five (5) CSEC passes, with at least one (1) year general work experience.

Persons who are age eighteen (18) or over, possess less than the standard five (5) CSEC passes, with no work experience.

Non Academic Route

Persons who are age eighteen (18) or over, do not possess any CSEC passes, with no work experience.

N.B. a) Applicants seeking entry via routes x to y will be subject to an interview by the Admissions Committee.
b) Applicants seeking entry via routes x to y, as a prerequisite, will be required to complete a language programme to gain programme entry.

Financial
Government Assistance for Tuition Expenses (GATE)Funding
If you wish to obtain additional information about the GATE programme, you may visit http://www.e-gate.gov.tt/gate-app/ or call 800-GATE (4283).

Do you wish to apply for GATE funding?

Yes

Have you received prior GATE funding?

Yes

Higher Education Loan Programme (H.E.L.P)

Have you received prior H.E.L.P funding?

Yes

Intended Source of Funding

GATE

H.E.L.P

Commercial Bank

Credit Union

Self-funding

Combination of sources

Are you a member of a Credit Union?

Yes

Marketing Information

How did you learn about the IME?

Other ?

Student Declaration
The Student Declaration is a summary of the IME’s conditions under which a student is admitted and enroled into a programme.

I hereby certify that the information provided is accurate to the best of my knowledge

I agree to conform to the rules and regulations of the IME

I understand that my application may be rejected if any information is falsified

Application Date

Course

Submit

ADMISSION FORM

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