kpu surrey on-campus: aboriginal cohort dual credit … · not a citizen of canada *legal...

SURREY SCHOOL DISTRICT

KWANTLEN POLYTECHNIC UNIVERSITY

KPU SURREY ON-CAMPUS: ABORIGINAL COHORT

DUAL CREDIT COURSE

APPLICATION PACKAGE

2014/2015

Submit to your secondary school counselor

Contents

Application Checklist

Parent/Guardian Statement

Freedom of Information Release Form

KPU Third Party Waiver

Course Selection and Statement of Interest Form

Transition Plan

KPU Application

ON-CAMPUS: ABORGINAL COHORT

DUAL CREDIT APPLICATION


APPLICATION CHECKLIST Check each box when completed.

Step 1: School Recommendation and Document Review

Meet with your school counselor to review your eligibility and suitability (grades, attendance record, work habits, behavior and special needs information).

Complete your transition plan

Review course available in semester 1 and 2.

Have your counselor review the student application, directions for completion and deadlines for submission with you.

Step 2: Complete Application Package Application for Admission

Course Selection & Statement of Interest Parent/Guardian statement Freedom of Information Release

Attach Additional Documents Transcript of Grades

References from 2 of the following: administrator, counsellor and/or teacher **

Step 3: Submit Application Return completed application package to your counselor on or before: May 28, 2014

Step 4: Final Selection Application package will reviewed by the district

You will be informed of your admission status in the program within 2-3 weeks

**INSTRUCTIONS FOR REFERENCES:

Collect references from two of the following:

Administrator

Counselor

Teacher Request references to comment on your academic record and motivation & engagement

in the learning environment as well as other pertinent information.

Allow references a minimum of one week to prepare reference.




PARENT/GUARDIAN STATEMENT

Student’s Name __________________________________________________ Attending: Kwantlen Polytechnic University Parent/Guardian’s Name _______________________________________

I support my son/daughter’s participation in the on-campus dual credit program.

I am aware that Surrey School District will pay tuition costs for this program and that

students can be funded for up to two courses.

I am aware that students are responsible for arranging transportation to and from campus.

I am aware that KPU has waived the application fee and there are no student fees for this

program.

I am aware that there are textbook costs for this program for which students are

responsible.

Parent/Guardian Signature: Date:

APPLICANT SIGNATURE

I certify that all statements in this application package are true.

Student Signature: Date:




FREEDOM OF INFORMATION RELEASE

Student Name: ______________________________________ Birthdate:___________________

Program/Course(s) applied for ______________________________________________________

Kwantlen Polytechnic University is governed by the Freedom of Information and Privacy Act (FOIPPA)

and as such are not able to discuss student progress and attendance with a parent or guardian without

the permission of the applicant/student. Your signature below provides permission to both your

parent/guardian and your School District to access your student record information.

I give permission to share information about my student record, including grades, attendance and

performance with my parent/guardian and my School District during the current academic year,

September to June ______________________

Student Signature ___________________________________ Date_________________________

Name of Parent/Guardian___________________________________________________________

Address _________________________________________________________________________

Phone _______________________________ Email____________________________________

Office of the Registrar form Rev. 11-Oct-13

Third Party Waiver/Release of Information Form

Submit form to Student Enrolment Services on any campus.

Student Name: First Name

Last Name Student Number Date of Birth (dd/mm/yy)

Part I – Student Information

I authorize (print name of person/agency here) access to the following information:

Academic status Convocation information Enrolment status information Grades Registration information (including current registration status) Special needs documentation/Disability accommodations Other (specify)

Part II – Financial Information (Note: refund cheques will only be issued to the student, not a third party, even in cases where a waiver is in

place)

I authorize (print name of person/agency here) access to the following information:

Student account balance Student awards Student loan information Tuition and fees assessment Other (specify)

Part III – Student Transactions

I authorize (print name of person/agency here): to carry out the following transactions on my behalf:

Add/drop courses Pay fees Order transcripts, confirmation of enrolment letters, signed scholarship/RESP forms Other (specify)

Part IV – Duration (waivers are valid for a maximum of one year only from the start date)

This waiver will be valid for the following period:

From: Date (day/month/year) To: Date (day/month/year)

IMPORTANT!! Access to online fee payment and registration services is controlled through each student’s User ID and PIN (password). It is the responsibility of each student to control access to their PIN. Under no circumstances will a student’s PIN be released to a third party, even in cases where a third party waiver has been signed.

Part V – Signature - Student records are confidential and are not changeable without the written consent of the student, unless otherwise

required by law. Your signature indicates that you are requesting your records be revised and that information contained herein is accurate to the best of your knowledge. KPU considers a falsified waiver form as fraud.

Student signature

Date

Office Use Only Date received:

Received by: Date entered (dd/mm/yy):




COURSE SELECTION AND STATEMENT OF INTEREST

Name:________________________________________________________

IDEA 1100: Interdisciplinary Foundations

What's the point of university? Why are we here? What should we do? This course explores

these questions through the lens of interdisciplinary inquiry and creativity. The course includes a

diverse number of current interdisciplinary approaches to help learners ask — and answer, in

their own ways — questions about purpose, meaning, and direction.

This course will be offered Thursdays, 1:00pm-4:00pm at the Surrey Newton Campus.

Details about the course for Spring 2015 will be announced in September.

STATEMENT OF INTEREST

Please respond to the following questions on a separate piece of paper and attach to this page.

1. What has motivated you to start university course work while still in high school?

2. Describe how the courses you have selected will contribute to your transition plan after high

school graduation.

3. Describe your knowledge, skills and attitudes that will support you to do well in university course

work.

4. What part(s) of attending university do you believe will be the most challenging for you and how

you plan to address that challenge(s)?

SURREY SCHOOL DISTRICT

Transition Plan for School Year ____________ to ____________

NAME: ______________________ ON-CAMPUS at KPU SFU

First Last

FOCUS AREA: __________ GRADE: HOME SCHOOL:

GRADE 10 REQUIREMENTS

CREDITS

ANTICIPATED OR ACTUAL COMPLETION

DATE Month/Year

LOCATION If taken online or at another school

a Language Arts 10

a Mathematics 10

Physical Education 10

Planning10

Science 10

a Social Studies 10

__4_

__4_

__4_

__4_

__4_

__4_

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GRADE 11 REQUIREMENTS CREDITS LOCATION

a Language Arts 11

a Mathematics 11 / 12

a Science 11 / 12

a Social Studies 11 / 12

__4_

__4_

__4_

__4_

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GRADE 12 REQUIREMENTS CREDITS LOCATION

Graduation Transition program

a Language Arts 12

__4_

__4_

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__________

_________________

_________________

FINE ARTS &/OR APPLIED SKILLS REQUIREMENT Either 4 credits of one area, or 2 credits of each

CREDITS LOCATION

an Applied Skill 10 / 11 / 12

a Fine Arts 10 / 11 / 12

_____

_____

__________

__________

________________

________________

Total credits required from required courses 52 CREDITS

ELECTIVE COURSES: other credits CREDITS LOCATION

_________________________ 10 / 11 / 12 (circle grade)

____________________________ 10 / 11 / 12

____________________________ 10 / 11 / 12

____________________________ 10 / 11 / 12

____________________________ 10 / 11 / 12

____________________________ 10 / 11 / 12

____________________________ 10 / 11 / 12

____________________________ 10 / 11 / 12

____________________________ 10 / 11 / 12

____________________________ 10 / 11 / 12

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ELECTIVE COURSES: ON-CAMPUS

CREDITS LOCATION

__________________________

_____________________________

____

_____

_________

__________

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________________

Total credits required from elective courses 28 credits (Minimum) MINIMUM REQUIRED TO GRADUATE 80 credits

HIGH SCHOOL GRADUATION DATE _____/______ Month / Year POST-SECONDARY PLANS: _________________________________________________________________________________________ __________________________________________________________________________________________________________________ I have discussed the completion of my transition plan with my parent(s) /guardian(s).

Student Signature: ______________________________________________ Date: _______________________________________

Parent Signature: ______________________________________________ Date: _______________________________________

School Counsellor Signature: ______________________________________ Date: _______________________________________

Telephone: 604.599.2000

Telephone: 604.599.2000

Email: [email protected] www.kpu.ca/admission

Please use a black ink pen when completing this form

FULL LEGAL NAME (NO INITIALS)

Surname (Legal Last/Family name)

Former Surname (if applicable)

Legal Given First Name

Legal Given Middle Name

Preferred First Name

Preferred name is displayed in KPU’s e-learning environment

CONTACT INFORMATION

Email Address

Mailing Address

City / Municipality

Province

Postal Code

Home Telephone

Cellular/Mobile Phone

PERSONAL INFORMATION CITIZENSHIP STATUS OPTIONAL *Gender Male Female * Date of Birth * Gender and date of birth are required for you to access the online student system and for identification purposes.

Country of Citizenship _____________________________________________ First Language____________________________________________________ Country of Birth___________________________________________________ Citizenship Status*

Canadian Citizen

Permanent Resident (landed Immigrant) Approved Convention Refugee Minister’s Permit Diplomat or Dependent Not a Citizen of Canada

*Legal documentation may be required

KPU is dedicated to Aboriginal student success. An Aboriginal person is identified as “an Indian, Métis or Inuit person of Canada” [Constitution Act of 1982, Part II, Section 35(2)].

I wish to be identified as an Aboriginal person.

If you have chosen to identify as an Aboriginal person, for statistical purposes we invite you to select one or more of the three options that best describes your Aboriginal identity:

Indian/First Nations (include Status, non-Status, Treaty and non-Treaty)

Métis

Inuit

Please contact me regarding Aboriginal student support and services

Last updated April 2014

Before completing this application, refer to the University calendar at www.kpu.ca/calendar for information on KPU’s programs and admission requirements. You may wish to discuss your goals with

one of our Educational Advisors or Counsellors prior to applying. This section of the application MUST be completed.

DESIRED PROGRAM OF STUDY Program Code

HSOC_S_UN

Student No: ___ ___ ___ ___ ___ ___ ___ ___ ___

Program Name

High School/KPU Concurrent Studies

Start Term/Year

Campus Langley Cloverdale Richmond Surrey

Application for Admission

MM

YYYY

DD

MAILING ADDRESS

Office of Admissions

Kwantlen Polytechnic University

12666 – 72nd Avenue, Surrey

BC , Canada V3W 2M8

EMERGENCY CONTACT

Surname (Legal Last/Family name)

Legal Given First Name Telephone

ADDITIONAL INFORMATION

I am requesting information on student services related to:

Illness or disability Students with children Scholarships and financial assistance

SECONDARY SCHOOL EDUCATION (HIGH SCHOOL) If you are presently attending Secondary (High School), when will you graduate?

If you have already left high school, when did you graduate? Relationship to applicant

School Name

Last School

Location

Location

Present Grade

Date Term Ends

Will you be graduating?

Personal Education Number (BC only)

If you are currently attending grade 12 in B.C. you need to submit the Post-Secondary Institution (PSI) Selections form between Nov—Jun of the school year to ensure your grades are released to Kwantlen Polytechnic University. The form is available online at: www.bced.gov.bc.ca/transcript/transcripts_info.

If you are utilizing your Secondary School Academic Record for eligibility for admission to undergraduate-level studies and for meeting program and/or course requirements, you must request an official, sealed transcript to be sent from the issuing body/department of education to KPU Admissions. More information about required document submission can be found at www.kpu.ca/admission.

PREVIOUS POST-SECONDARY EDUCATION (COLLEGE OR UNIVERSITY)

_________ _________ _________ _________

1. Institution Name Location Month Year to Month Year

_________ _________ _________ _________

2. Institution Name Location Month Year to Month Year

Have you ever been suspended / expelled from any post-secondary institution and/or program? Yes No

To apply for transfer credit (to meet prerequisite requirements, graduation requirements or receive transfer credit standing) you must request an official sealed transcript be sent to KPU directly from the issuing institution, fill out a Request for Transfer Credit form and submit the required fee (if applicable). Please allow up to eight weeks for official assessment. Submission deadlines, to ensure evaluation by the beginning of registration, are published online at www.kpu.ca/transfercredit

LEGAL

I certify that all statements on this application are true and complete and that no information has been withheld. I understand that any misrepresentation of this may result in the cancellation of my admission or registration status and that falsifying documents or information on the application may result in immediate permanent dismissal from Kwantlen Polytechnic University. Completion of this signed application permits Kwantlen Polytechnic University to request and/or confirm any information necessary to support my application for admission.

I authorize the release of all British Columbia secondary school interim and final grades by the British Columbia Ministry of Education to Kwantlen Polytechnic University. If I am admitted to Kwantlen Polytechnic University, I agree to familiarize myself with and to abide by the most current policies of the University during my tenure as a student at the University.

In signing this application for admission, I understand that this information, along with subsequent information placed in my student records will be used for the purposes of admission, registration, graduation, research, alumni and development, student association and other purposes consistent with the mandate of the institution. Kwantlen Polytechnic University reserves the right for the Registrar to share information with the Ministry of Advanced Education, Training and Technology, or other related government agencies and dual enrolment partners. Kwantlen Polytechnic University also reserves the right for the Registrar to share information with other post-secondary institutions in situations where an applicant has been found to have falsified documents or other information on their Application for Admission. The use of this information will be in compliance with the Freedom of Information and Protection of Privacy Act. The information on the admission form is being collected under the authority of the University Act.

Signature:__________________________________________________________________ ____ Date: _________________________________________________

FOR OFFICE USE ONLY (Do not write in shaded areas)

Date Entered By:

Initials

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Last updated April 2014