2016 - 2017

PROGRAM APPLICATION PACKAGE Revised September 2016

Submit to your Secondary School

Career Education Contact or Coordinator

SOUTH ISLAND PARTNERSHIP PROGRAM APPLICATION INFORMATION

GETTING STARTED

Students and parents meet with a school career coordinator/counsellor to discuss SIP program options.

Visit our website: camosun.ca/learn/south-island-partnership. Questions can be directed to your school career

coordinator/counsellor or the SIP office (250-370-4827, email SIP@camosun.bc.ca).

Important: college course(s) will be recorded on your permanent post-secondary file. Careful consideration is to be made when deciding to take a post-secondary program.

Students should not take a post-secondary program unless they are prepared to attend all classes and complete all assignments.

Withdrawal Process: Students wishing to withdraw from a program must first contact the SIP Office immediately.

Individual Education Plan (IEP): Students with a learning condition or other disability which may require additional

support services should make an appointment with the Disability Resource Centre (250-370-4049).

HOW TO APPLY (please complete all forms in ink)

See your school career coordinator/counsellor for assistance completing this package.

ACE IT trades students will also fill out an Industry Training Authority (ITA) Apprentice/Sponsor registration form.

Return the completed application package to your school career coordinator/counsellor for submission to:

SIP Office, Camosun College, Jack White Building Room 105C, 4461 Interurban Road, Victoria, BC V9E 2C1

or via Fax: 250-370-3723 (only when payment is made with a credit card).

Sample the Campus applications are supplied by April Atkins (AtkinsA@camosun.bc.ca; 250-370-4827).

Students are accepted based on meeting qualifications and date of application received in the SIP office.

Students will be notified if qualified and accepted into the program. Program applicants will be required to attend an

orientation. ACE IT (trades) students may be required to complete an assessment.

Where applicants exceed availability, a waitlist may be established.

APPLICATION SUBMISSION CHECKLIST (please complete all forms in ink)

Completed SIP Application Form, including ALL signatures

Application Fee (via credit card or cheque made payable to Camosun College) *non-refundable

Signed Permission to Release Information Form (a College requirement)

Completed and signed Responsibility Agreement AND Student Statement of Commitment forms

Completed and signed Student Education/Transition Plan

Transcript of marks for the last completed year, including grades ten and eleven

Teacher Recommendation Form or Attendance Record

Evidence of 30-hour related Work Experience

Completed and signed Sponsorship Form, where applicable

English & Math Assessments, where applicable

NOTES:

Incomplete applications will be returned to the high school, unprocessed.

Tuition fees will be paid by your school district.

You are responsible for the non-refundable application fee, textbooks, equipment, supplies, and clothing.

Fees may change without notice.

DUAL CREDIT PROCESS

Students will receive high school credits and marks on their high school transcript.

Students will also receive college credit for the program. Apply for a college transcript to receive your report. http://camosun.ca/services/_documents/transcript-request.pdf

Program Acceptance Disclaimer: These programs may not be governed by Camosun College’s policies on admission and

academic progress and promotion.

Have you applied to or attended Camosun College before?

Yes No

If yes, what is your Camosun College Student Number?

C _ _ _ _ _ _ _

SOUTH ISLAND PARTNERSHIP APPLICATION FORM

PERSONAL INFORMATION (please print clearly)

LEGAL LAST NAME FORMER LAST NAME (if applicable)

LEGAL FIRST NAME PREFERRED FIRST NAME (if applicable) MIDDLE NAME(S) Check if you have none

CITIZENSHIP STATUS Canadian

If you are not a citizen of Canada, please select your official status in Canada (documentation required):

Permanent Resident/Landed Immigrant, provide copy of card front and back:

Other Visa or Permit, provide copy of passport picture and Study Permit:

DATE OF BIRTH

___ ___ / ___ ___ / ___ ___ ___ ___

GENDER

Male Female

SOCIAL INSURANCE NUMBER (optional*)

___ ___ ___ - ___ ___ ___ - ___ ___ ___

*Providing your SIN helps us to ensure the accuracy and completeness of your transcript and your tuition tax receipt.

CONTACT INFORMATION

MAILING ADDRESS CITY PROVINCE POSTAL CODE

STUDENT HOME TELEPHONE NUMBER

________ - ________ - ____________

STUDENT CELL PHONE NUMBER

________ - ________ - ____________

STUDENT EMAIL

PARENT EMAIL

PARENT/GUARDIAN NAME PARENT/GUARDIAN PHONE NUMBER

________ - ________ - ____________

EMERGENCY CONTACT NAME RELATIONSHIP TO STUDENT EMERGENCY CONTACT PHONE NUMBER

________ - ________ - ____________

PROGRAM CHOICE (A collection of courses that usually leads to a credential, such as Welding or HCA)

PROGRAM (full-time) PROGRAM LOCATION PREFERRED START DATE ___ ___ / ___ ___ ___ ___

ACE IT Apprenticeship

ACE IT Foundation

COURSE CHOICE (A course covers one subject, such as Math 100 or Engl 151. Include section #)

COURSE COURSE LOCATION COURSE START DATE ___ ___ / ___ ___ ___ ___

COURSE COURSE LOCATION COURSE START DATE ___ ___ / ___ ___ ___ ___

COURSE COURSE LOCATION COURSE START DATE ___ ___ / ___ ___ ___ ___

COURSE COURSE LOCATION COURSE START DATE ___ ___ / ___ ___ ___ ___

SECONDARY SCHOOL (HIGH SCHOOL) INFORMATION

BC Personal Education Number (PEN) if known

___ ___ ___ ___ ___ ___ ___ ___ ___

GRADE CURRENTLY ENROLLED IN EXPECTED GRADUATION DATE

___ ___ / ___ ___ ___ ___

SECONDARY SCHOOL NAME SD # TEACHER / COUNSELLOR NAME (please print): APPROVAL (signature):

DATE

South Island Partnership Camosun College

4461 Interurban Road Victoria BC V9E 2C1

250-370-4208 SIP@camosun.ca

M M D D Y Y Y Y

M M Y Y Y Y

TRANSCRIPTS

1. Submit up-to-date high school grade information (unofficial transcript) with this application. 2. To request transfer credit assessment at Camosun College for course(s) taken at another institution to meet prerequisite requirements or credential requirements, you must submit

official transcripts. When submitting official paper transcripts, they must be in an envelope sealed by the sending secondary school (high school). For dated and out-of-province transcripts, you may be required to submit official course outlines. Official transcripts from out-of-country must be accompanied by official course outlines (if in languages other than English, you must include official translations into English).

ACCEPTANCE TO A PROGRAM

All program applicants will participate in an orientation prior to acceptance to a program. Acceptance is subject to seat availability, completion of prerequisites, and work experience. Application fees are processed upon acceptance into a program. This does not apply to course applications.

VOLUNTARY DISCLOSURE

By completing this section, you indicate you understand that you may be contacted by the school, based on the information you provide (extra college services may be available).

Are you of Aboriginal ancestry? (First Nations, Mėtis or Inuit) Yes No

If Yes, are you First Nations Status First Nations Non-Status Inuit Metis

Do you have an Individual Education Plan (IEP), a learning condition or other disability for which you may require additional support services?

Yes No If Yes, your next step is to make an appointment with the Disability Resource Centre www.camosun.ca/drc 250-370-4049

WITHDRAWAL POLICY

To receive full tuition refund, you must withdraw within two weeks of the start of class. To avoid a permanent academic record for low achievement, students may withdraw from a course prior to the withdrawal deadline. The deadline to withdraw without academic penalty falls after completion of 66% of the academic term. For all withdraws or for more information, contact the South Island Partnership office.

DECLARATION

The personal information on this form and other personal information which forms part of your student record is collected under the legal authority of College and Institutes Act, [RSBC 1996] c.52, and the Freedom of Information and Protection of Privacy Act [RSBC1996] c. 165. The information is used for administrative and statistical research purposes of the College and/or the ministries or agencies of the Government of British Columbia and the Government of Canada. The information will be protected, used, and disclosed in compliance with those acts. Except as provided in the foregoing, the personal information collected on this form and other personal information which forms part of your student record will not be disclosed to any other person without your consent. A “Permission to Release Information” form, available from Student Services and camosun.ca, must be signed in order for Camosun College to provide access or release your personal information to any other person. However, Camosun College may be required to release a student’s personal information if it becomes aware of compelling circumstances where there is a risk to the health and safety of the student or others. Please read the following before signing:

1. I declare that the information contained in this application is to the best of my knowledge complete and correct. 2. I agree to abide by the rules and regulations of the college. 3. I understand the application fee is non-refundable, is required from all applicants to a course, and that the application will not be processed until this fee is received. 4. I understand and agree that acceptance of this application in no way guarantees admission to the course and that this application is subject to the availability of seats. I understand

and agree the college reserves the right to modify or cancel any course without notice or prejudice.

__________________________________________________________ ________________________________ Signature of Applicant Date

__________________________________________________________ ________________________________ Signature of Parent/Guardian Date

FEES

APPLICATION FEE - Payment is due with each application (non-refundable)

(Cash will not be accepted) $40.20

Invoice School District __________

Cheque or Money Order (attach) Payable to Camosun College

Visa Mastercard American Express JCB Card No: _________ _________ _________ _________ Expiry ____ / ____

Name of Card Holder:

TUITION FEE (Credit card and cash will not be accepted)

Invoiced by SIP Office (contact SIP office to confirm method) Secondary students completing an application to register in a college course are often sponsored by the school district. To confirm sponsorship eligibility, speak with your high school counsellor for details

School to identify if a student is reported through DL Yes No

External Sponsorship Form

M M Y Y

PERMISSION TO RELEASE INFORMATION

AND

AUTHORIZATION TO ACT ON MY BEHALF

The British Columbia Freedom of Information and Protection of Privacy Act provides that the college may not

release any information pertaining to student records to anyone other than the student owner of the record

without the student’s consent.

Further, the college does not normally allow any person other than the student to conduct student-related

business with the College on behalf of the student.

In order to allow the South Island Partnership and your parent(s)/guardian(s) to conduct student-related

business on your behalf, you must complete and submit this form as part of the SIP application package.

Student Name: _______________________________________ ____________________________________

Last Name (please print) First Name (please print)

Camosun Student #: C (Office Use Only) Date of Birth (mo/day/year): ________________

To the Enrolment Services Department:

The following secondary school ___________________________________________________________________

and Parent(s)/Guardian(s) (please print) ___________________________________________________________

have permission to access my student records and conduct student-related business on my behalf while I am

registered in a South Island Partnership course/program.

Student Signature: _________________________________________________ Date: __________________

Questions?

South Island Partnership Phone 250-370-4208, Email SIP@camosun.bc.ca

RESPONSIBILITY AGREEMENT - PROGRAMS

We will:

High School/School District, SIP, and Camosun Responsibilities

provide tuition funding for program training at Camosun College

inform you of the training requirements specific to your career area and provide you with background information on

requirements for Camosun College

assist you to meet all prerequisites and create an Education/Transition Plan that maps your final years of high school help you to complete a SIP application package and submit it to SIP on your behalf

register you as an ACE IT student (for trades programs only)

provide you with student support services as needed (assessment, learning skills, English and/or math upgrading,

counselling, disability resources)

encourage you to be proactive in informing the Disability Resource Centre of specific learning needs and IEPs (make an

appointment with our DRC by calling 250-370-4049)

liaise with your parents, high schools teachers, and Camosun instructors regarding your college progress and

participation

provide post-secondary marks to your high school for graduation credits

Student Responsibilities As a South Island Partnership student, I agree to:

understand that punctuality and attendance are mandatory at Camosun

contact my instructor and the SIP office (250-370-4826) immediately if I will be absent or late

follow the Camosun College Student Conduct Policy (refer to http://www.camosun.bc.ca/learn/becoming/policies.html)

respect that my home school Code of Conduct applies to all courses and programs

respect, compliance, and effort are required at all times

successfully meet all prerequisites before attending Camosun

participate in a Math or English upgrading program/assessment if deemed necessary

undergo a relevant work experience placement in my chosen program area

submit a completed application package and the application fee to my high school career counsellor

attend a SIP orientation when invited

meet program homework and study expectations (2-4 hours daily)

strive to achieve a passing mark of at least 70% in my program

inform my Camosun instructor and my school career coordinators of withdrawal from my courses as soon as possible

understand that failure to withdraw in advance of 66% of program completion may result in an “F” on both my high school and post-secondary transcripts; (withdrawal must occur before the final third of the course begins)

be aware that if I require an extension, I will be responsible for both tuition and student ancillary fee payment

understand that it is recommended that students attend after-session tutorials offered by the instructor

purchase required text books, support materials, equipment, and clothing

contact the SIP office should I need assistance (250-370-4827)

Student Name (please print clearly):

Student Signature: Date:

Parent/Guardian Name (please print clearly):

Parent/Guardian Signature: Date:

Career Counsellor Name:

High School: _______________________________________________

STUDENT STATEMENT OF COMMITMENT

Students applying to take a program must complete this form.

Student Name:

(please print clearly)

Describe why this is the career area for you.

Date:

_

Describe how your work experience or school activities have prepared you for this program.

_

Describe what you will do to be successful in this program. Student Signature: ________________________________________________________ Date: _____________________

TEACHER RECOMMENDATION FORM

Student Name:

ACE IT Program Applying for:

Teacher Name:

Subject: (Related to Program applied for)

Current letter grade: Absences _ Lates

Please check the following traits as:

Excellent

Good

Satisfactory

Needs

Improvement

Maturity

Ability to follow instructions

Enthusiasm and interest

Adaptable – adjusts to new tasks

Follows through on assigned tasks

Attendance

Punctuality

Shows motivation to learn new skills

Can work independently

Has positive attitude towards work

Accepts constructive criticism

Please comment on the student’s readiness for post-secondary learning

Teacher Signature: Date: