Fillable Request for Membership Reinstatement Form (College of Early Child Educators)

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Request for Membership Reinstatement Form (College of Early Child Educators)

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Country of origin: CANADA
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Date (dd/mm/yy)
I confirm that all the information contained in this Membership Reinstatement Form and related
documents is true.
I
acknowledge that any false or misleading statement, representation or declaration in or in
connection with this Membership Reinstatement Form may be cause for disciplinary action.
By checking this box and typing/printing my name I confirm my understanding and agreement
to the terms of this Membership Reinstatement Form.
438 University Avenue, Suite 1900
Toronto ON M5G 2K8
Telephone: 416 961-8558 Toll-free: 1 888 961-8558
E-mail: reinstatements@college-ece.ca
Website: college-ece.ca
Request for Membership Reinstatement Form
To complete this form, you must download and save a blank copy to your computer. Close your
Internet browser and open the saved copy from your computer files. Now you may print off a hard
copy or enter your information electronically.
Membership Reinstatement Requirements
Use this form if you are a former member whose Certificate of Registration has been cancelled/resigned or
suspended.
If you are a former member, you only have a three year window from the date of your
cancellation/resignation or suspension to apply to have your membership reinstated. After this period, you
must re-apply to become a member of the College.
Complete all sections of this Membership Reinstatement Form and submit it to the College of
Early Childhood Educators, along with any supporting documents and the reinstatement fees. For
instructions, see college-ece.ca/reinstatement_guide for details.
Section 1: Confirmation of Former Member’s Understanding
Confirm your member understanding by putting a check markby each of the 3 statements below.
Former member’s full name
Section 2: Former Member Information
Last name
First name
Middle name(s) Date of birth
Common first name (as it will appear on the College’s public register)
Registration number
CECE - Request for Membership Reinstatement Form - 2022
Page 1 of 6
City
Postal Code
Section 2: Former Member Information cont'd
Home address: Street name & number
Unit #
R.R.
P.O. Box
Province/Territory/State
Country
Home telephone number (include area code)
Mobile telephone number (include area code)
Postal Code
R.R.
P.O. Box
a. Place of employment
Business name
Business address:
Unit #
Province/Territory/State
City
Country
b. Business telephone number (include area code)
c. Business fax number (include area code)
English
French
Communications from the College
Preferred mailing address for communications from the College
Home address Business address
Preferred language of communication from the College:
Preferred e-mail address (please include an e-mail address that is accessed only by you in order to
receive communications from the College):
Are you currently: Employed Unemployed
If you checked the box to indicate you are employed, please provide the following:
For statistical purposes only
I identify my gender as: Female Male
If neither term above applies to you, please check
this box.
Optional: I choose to
self-identify with any of the following:
Indigenous heritage Francophone
CECE - Request for Membership Reinstatement Form - 2022
Page 2 of 6
By checking this box and typing/printing my name I authorize the College to charge the
credit card below in the amount of C$
Cardholder’s name: (please print as it appears on the credit card):
Card number:
Exp. date (mm/yy):
CVV (Card Verification Value) number – The 3 digit number located on the back of your card:
Visa
Visa Debit MasterCard
Section 3: Reinstatement Fees
See the college-ece.ca/reinstatement_guide to determine the fees you must pay.
Please note the different reinstatement fees below. Please check the description and the corresponding
fee (in Canadian dollars) that applies to you:
Reinstatement Fee
and
Annual Fee
$90 - I am seeking reinstatement following resignation or suspension
+
$160 - if applicable
Please check the method of payment being submitted:
Cheque / money order / bank draft # made out to the College of Early Childhood Educators
Cheque / money order / bank draft #:
Amount C$
Online banking through your financial institution (see college-ece.ca/reinstatement_guide)
Bank confirmation/reference # Amount C$
Date (dd/mm/yy)
CECE - Request for Membership Reinstatement Form - 2022
Page 3 of 6
2. Since you were last a member of the College, have you been found guilty of professional
misconduct, incompetence or incapacity in the practice of early childhood education or any
other profession (in any jurisdiction)? Please only answer “Yes” if you were found guilty by an
organization that is NOT the College of ECE.
Yes
No
3. Since you were last a member of the College, to your knowledge, are you being investigated
for professional misconduct, incompetence or incapacity, in the practice of early childhood
education or any other profession (in any jurisdiction)? Please only answer “Yes” if you are
being investigated by an organization that is NOT the College of ECE.
Yes
No
4. Since you were last a member of the College, have you been charged and/or found guilty of an
offence under the Controlled Drugs and Substances Act (Canada) or the Food and Drugs Act
(Canada)?
Yes
No
1. Since you were last a member of the College, have you resigned your membership or registration
with a regulatory/ licensing organization while you were the subject of a complaint, investigation or
proceeding with respect to professional misconduct, incompetence or incapacity in the practice of
early childhood education or any other profession (in any jurisdiction)?
Yes
No
Section 4: Issues Potentially Affecting Practice
You must answer ALL of the questions in this section.
CECE - Request for Membership Reinstatement Form - 2022
Page 4 of 6
5. Since you were last a member of the College, have you been char
ged and/or found guilty of a
criminal offence in Canada or in any jurisdic
tion outside of Canada?
Yes
No
6. Do you have a physical or mental condition or disorder that affects your ability to practise the
profession safely? Please only answer ‘Yes’ if you have never disclosed this information to the
College, or if you have already disclosed it and this information has substantially changed since you
did so.
Yes
No
7. Since you were last a member with the College, have y
ou been charged with misconduct,
including academic misconduct that resulted in disciplinary actions by the Dean’s office (or
any equivalent or higher administrative office) while you attended a post-secondary institution?
Yes No
8. Since you were last a member of the College, has a Children’s Aid Society or equivalent authority
in any jurisdiction verified allegations or concerns made against you?
Yes No
Yes
No
6. Do you have a physical or mental condition
or disorder that may affect your ability to practise the
profession?
Yes
No
Section 4: Issues Potentially Affecting Practice cont'd
You must answer ALL of the questions in this section.
9. Since you were last a member of the College, have you had a Director’s approval for you to work
as a supervisor in an ECE setting removed?
Yes
No
10. Since you were last a member of the College, have you held a licence to operate a child care
centre under the Child Care and EarlyYears Act?
Yes No
If you answered “Yes” to question 10, answer the following:
a. Have you been found guilty of an offence under the Child Care and Early Years Act or
are you currently being investigated for an offence under that Act?
Yes No
b. Has a Director appointed under the Child Care and Early Years Act revoked or
refused to renew your child care centre licence?
Yes No
If you answered “Yes” to any of the questions in this section (i.e., Section 4), see college-ece.ca/
reinstatement_guide for instructions on providing more detailed information and attach additional
documents.
CECE - Request for Membership Reinstatement Form - 2022
Page 5 of 6
I understand that I must hold a Certificate of Registration in good standing with the College of
Early Childhood Educators (the College) in order to practise as an early childhood educator in
Ontario.
Yes
b) I understand that I cannot use the protected titles or designations “early childhood educator”
(ECE) or “registered early childhood educator” (RECE) or their French equivalents unless I
hold a Certificate of Registration in good standing with the College.
Yes
c) I understand that the College may require additional information (including supporting
documents) in connection with this reinstatement.
Yes
d) I understand that if there are any changes to the information provided on this Membership
Reinstatement Form, including my contact information, I am required to notify the College
within 30 days of that change using the Change of Information Form.
Yes
I confirm that I have read and agreed with all of the above conditions and verify all information in
this Membership Reinstatement Form is authentic and true.
Yes
Review and Finalize Your Membership Reinstatement Form
Please review this form and ensure it is complete before submitting with supporting documents
(if appropriate). See instructions at college-ece.ca/reinstatement_guide.
Your privacy matters. For more information on how we protect your data and the way it can be used, please visit college-ece.ca/privacy-statement.
Section 5: Acknowledgement
Confirm your member understanding by putting a check markby each of the 5 statements below.
CECE - Request for Membership Reinstatement Form - 2022
Page 6 of 6
a)
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Completed 19 February 2022

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