<p> THE UNIVERSITY OF THE WEST INDIES ST. AUGUSTINE, TRINIDAD AND TOBAGO, WEST INDIES</p><p>ACADEMIC SUPPORT/DISABILITIES LIAISON UNIT {ASDLU} Telephone: (868) 662 2002 - Extensions: 83866, 83921, 83923, 84254 ♦ Fax: (868) 662-2002 Ext.83922 ♦ E-mail: [email protected] ______EXAMINATION INVIGILATION REGISTRATION FORM</p><p>NAME: ______LAST FIRST</p><p>SEX: FEMALE MALE TELEPHONE#: ______</p><p>(Choose one) *ID#: STAFF: ______STUDENT: ______NATIONAL: ______</p><p>E-MAIL ADDRESS: ______</p><p>POST-GRADUATE STUDENT STAFF OTHER FACULTY & DEPARTMENT: ______</p><p>OTHER: ______</p><p>QUALIFICATION: ______</p><p>EXPERIENCE: ______</p><p>______</p><p>REFERENCE: (MUST BE PROVIDED)</p><p>1) NAME: ______TITLE: ______CONTACT: ______</p><p>SIGNATURE: ______DATE: ______</p><p>*Please note that you are required to submit a copy of your ID. ------OFFICIAL USE ONLY</p><p>APPROVED NOT APPROVED </p><p>SIGNATURE: ______CO-ORDINATOR, ASDLU</p><p>Revised October 2012</p>