Learner Information – Most Recent Info Prior to Start of Program – University of Toronto Physical Therapy Department

Legal Name as appears on your personal ID*

First Middle Last

Preferred Name

First

Date of Birth*

Cell Phone*

Personal Email*

Address in Ontario*

Street Address Address Line 2 City Province Postal Code

Country where you received your PT Education*

Year you graduated- Bachelors of PT*

Do you have a Master's Degree?*

Do you have a PhD?*

Length of Time in Canada*

Immigration- When you first arrived in Canada which province did you land in?*

Ontario - How long have you lived in Ontario*

Are you considering moving away from Ontario when the program is finished?*

Years of experience as a PT outside of Canada*

Number of Years in Canada not practicing as a PT*

Are your currently employed and/or self-employed?*

What is your current employment status?*

If you are employed, what is your current job title?

I have attempted the Written Component of the PCE*

I have attempted the Clinical Component of the PCE*

Are you currently registered to take one of the National PCE exams? If yes, what is the date?

If you are NOT currently registered to take one of the National PCE exams? What is the goal date?

Learner Information – Most Recent Info Prior to Start of Program