Equivalency Credit and PLAR Application Form Centre for Conflict

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					                                        Equivalency Credit and PLAR Application Form
                                                Centre for Conflict Resolution
Full Name


Home Address                                                               Mailing Address (if different)
Street                                                                     Street


Apt #                                                                      Suite/Floor/Box #

City                                                                       City

Province                                                                   Province

Country                                                                    Country

Postal/Zip Code                                                            Postal/Zip Code

Contact Information
Home Phone                                                                 Business Phone
                       (            )                                                             (             )
Fax                                                                        Email
                       (            )
For identification purposes:
JI student #                                       BC PEN                                         Date of Birth:
if known:                                          if known:                                      (YYYY/MM/DD)

Centre for Conflict Resolution course(s) for which I would like to receive credit:




Check all that apply
      EQCR1A BC/Yukon Post-Secondary Equivalency               Fee: $0        Enclose proof of completion of equivalent course(s)
      EQCR 1B Other Training Equivalency                       Fee: $25       Enclose proof of completion of equivalent course(s)
      EQCR 2 Training not on Equivalency List                  Fee: $150      Enclose course details and proof of completion for the course(s)
      PLAR1 Work/Life Experience                               Fee: $250      Enclose self-assessment for each course applied for
Note: If you wish to apply under more than 1 type, the highest single fee applies to your entire application.

Payment Information (Please note that your application fee is non-refundable)
   Cheque Enclosed (Please make cheques payable to the Justice Institute of BC)                   Visa               MasterCard
Card Number                                                           Expiry Date

Name on Card                                                               Cardholder Signature

Applicant Signature:                                                       Date:



                        Mail your completed application, supporting documentation and applicable fee to:
                               Elly Macmaster, Centre for Conflict Resolution, Justice Institute of BC
                                      715 McBride Blvd., New Westminster, BC V3L 5T4
                                                                   ccrplar@jibc.ca