Student Verification Form

As a Course Student you may have been instructed to submit your information and proof of official identification in order to receive certification for a specific course. Please ensure that you complete ALL the fields that are mandatory which will be identified by an asterix (*).

First Name*

Last Name*

CDN Number (If no CDN number write NONE)

Date of Birth (YYYY-MM-DD)*

Your Email*

Telephone*

Address*

Address 2

City*

State/Province/Region*

Zip / Postal Code*

Country*

Upload ID File - Please upload at least official Photo Identification (passport / driving licence) in Colour*

I confirm that as the person enrolled on this course I will undertake this course myself and without assistance from anyone else. I agree that if I allow anyone else to take all or any of this course for me, or I allow anyone else to help me, I will be in breach of Virtual Maritime Academy Terms and Conditions and the requirements of the relevant Awarding Body. I understand and accept that I, and the other person(s), may also be committing an offence. Any such events will be reported by Virtual Maritime Academy to my employer or agency (if this course has been arranged for me by my employer or agency) and to all relevant Bodies.

**If for some reason you cannot send your ID using this form, send it to us by email to course@virtualmaritime.academy and click next Lesson just below.