eReferral Mothercraft

Which type of Program are you contacting us about?

Who is the Applicant?

Which Mothercraft College of Early Childhood Education program are you interested in?

Does the client consent?

YesNo

Client consent is required to proceed with referral. Please call 416-364-7373 for more information.

Is the client aware this will create a record for them with Mothercraft?

YesNo

Client consent is required to proceed with referral. Please call 416-364-7373 for more information.

Do you require services in French?

YesNo

Please, contact Centre Francophone de Toronto at 416-922-2672 ext.274

Referral Information

Name of Staff Referring

Referring Organization

Reason for Referral

Phone

Fax

Person Information

First Name

Last Name

Date of Birth

Gender

Pronouns

Address

City

Country

Postal Code

Phone Number

Do Not Call

Do Not Leave Message

Primary Language

Other Language

Citizenship

Academic Education

Present Education

Emergency Contact

First Name

Last Name

Relationship

Phone

Address

City

Country

Postal Code

Please complete the following questionnaire:

Have you been employed or done volunteer work with children? If so, please state where you worked, describe your experience (i.e., type of work and duration, and with what ages children.)

What do you think an infant/Toddler teacher does? Please describe as fully as possible.

Why have you chosen to work with the very young child?

If you have a preferred age group, please discuss what characteristics of this age group you find challenging and rewarding

Infants	3 months to 18 months
Toddlers	18 months to 30 months
Preschoolers	30 months to 60 months
Schoolage	5 years to 10 years

What qualities do you feel are important in working with young children?

Have you any special skills which will be useful in working with young children?

What are your long term goals working with young children (ie., future training/ employment)?

Why have you selected Mothercraft's training program?

How did you hear about the program?

Please select one:

I have an Ontario Secondary School Diploma (OSSD) or equivalent

I don't have an OSSD and am applying for Mature Student Status (must be 18 years of age)

PLEASE NOTE: Copies of the following documents below MUST BE INCLUDED with your application.

Please check ALL boxes:

Copy of Canadian Birth Certificate or Canadian Passport, Canadian Citizenship or Permanent Resident Card

Copy of OSSD (Ontario Secondary School Diploma) or equivalent, if applicable

Two(2) letters of professional reference (each letter must be in signed, dated and include contact name and telephone number)

$100.00 application fee, cheque, money order, credit card payments must be made in person

Proof of SIN (Social Insurance Number) *Upon acceptance only*

Advanced Standing Credit may be available dependent on past experience and education. More information will be available upon acceptance into the Program.

After acceptance into the ECE Diploma Program and prior to placement, the student must provide to Mothercraft College of Early Childhood Education:

Please check ALL boxes:

Medical Health Form completed by physician and proof of COVID-19 vaccination (minimum of 2 doses)

Clear Police Vulnerable Reference Check

Proof of Standard First Aid and Infant Child CPR Certification Level C

*Please note the college will provide further instructions for the above process upon enrollment into the Early Childhood Education Diploma Program*

Is the person being referred pregnant?

YesNo

Pregnancy Due Date

Are children under six being referred?

YesNo

How many children under six?

More information is required to proceed with referral. Please call 416-364-7373 for more information.

Child 1 Information

First Name

Last Name

Date of Birth

Child Lives With

Other

Child 2 Information

First Name

Last Name

Date of Birth

Child Lives With

Other

Child 3 Information

First Name

Last Name

Date of Birth

Child Lives With

Other

Training Title

Training Date

Training Fee

Visit our website for fee information: https://www.tobedetermined.com/fees

Please check all that apply:

I am 18 years of age or older

I have experience working in a licensed child care or early learning setting

I am a RECE (Registered Early Childhood Educator)

I do not have any work experience in a child care or early learning setting

Not Applicable

Individuals who select “Not Applicable” will be unable to proceed with the submission process. Please call 416-483-0511 for more information.

Next Steps:

- Call our front office at 416-483-0511 (ext. 0) to pay the training fee with a valid credit card (VISA and Master Card only) * Registration is on a first come, first server basis*

- Wait for email correspondence from Mothercraft to confirm registration and training details

Child Info

Referral Information

Person Information

Emergency Contact

Please complete the following questionnaire:

Child 1 Information

Child 2 Information

Child 3 Information