Workplace Essential Skills & Training (WEST) Program .

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Workplace Essential Skills & Training (WEST)Program ApplicationThis information is used for assessment of program eligibility, support needs and planning.For applicants interested in attending WEST atthe Powell River Campus, please scan this formto pr.studentaffairs@viu.ca or deliver to thefront desk c/o:WEST ProgramVancouver Island University#100 - 7085 Nootka StreetPowell River, BC V8A 3C6604.485.2878Vancouver Island University WEST Application Form

APPLICATION FOR ADMISSIONAPPLICATION FOR ADMISSIONPlease ensure you print clearly and complete all sections of this application.APPLYING FOR ADMISSION TO VANCOUVER ISLAND UNIVERSITYFind a ProgramBrowse Vancouver Island University’s website at viu.ca to findinformation about programs offered.Contact Advising at 250.740.6410 (Nanaimo);250.746.3509 (Cowichan); 604.485.2878 (Powell River)if you require assistance choosing a program.Complete this formIf you prefer to apply online, please visit viu.ca/apply.Please ensure you print clearly and complete all sections ofthis Application for Admission.This Application for Admission can be delivered or mailedto any campus – Nanaimo, Cowichan, Powell River, or to theParksville Qualicum Centre.Pay the Application FeeA non-refundable application fee is required for eachapplication. If submitting the application by mail, you mayattach a cheque or money order payable to Vancouver IslandUniversity. If payment is not attached, we will mail you detailsregarding other payment options once we have completedinitial processing of your application.Program TypeFeeUndergraduate 40.90Master’s (Faculty of Management) 159.15Master’s (all other faculties)OFFICE USE ONLYDate Received:Application fee received:CPC:Submit Official TranscriptsNew applicants to undergraduate programs must submit officialtranscripts from all institutions. This includes high school andall previous post-secondary institutions. Faxed, scanned orphotocopied documents are not considered official. Transcriptsbecome the property of Vancouver Island University and willnot be returned. The only exception is where a transcript isdeemed to be irreplaceable. If submitting such a document,please request its return at the time of submission.Current high school students from BC and the Yukon mustprovide their Personal Education Number (PEN) and may also berequired to submit an interim transcript for admission purposes.New applicants to graduate programs must submit officialtranscripts from all previous post-secondary institutions.High school transcripts are not required from applicants tograduate programs.VIU Student NumberPersonal Education Number(for returning Students)Personal InformationLegal First Name (no initials)Middle Name(s) (no initials)Maiden Name/Previous Name (if applicable)Mailing AddressCityProvinceWithin two weeks of receiving your application, VancouverIsland University will mail you a letter confirming receipt ofyour application. Please read our letters carefully and call ifyou have any questions.Telephone (Primary)Telephone (Other)(( 106.05Application fees may be subject to change.Last NamePreferred NameWhat Happens Next?If you are admitted to a program, an offer of admission willbe mailed to you. A non-refundable, non-transferable deposit(usually 200) will be required to confirm your acceptance ofthe offer of admission. The due date to accept the offer andpay the deposit will be outlined in the letter of acceptance.Tradesperson ID Number(BC & Yukon High School Students)Postal Code)Date of BirthyearCountryEmail)Social Insurance Number (optional)monthGender Identity Man Woman Non-binarydayCitizenship Canadian Permanent Resident (documentation required) Country of Citizenship Refugee (documentation required) Country of CitizenshipEmergency ContactNameTelephone(Email)To Better Serve You, Please Answer these questionsWe are dedicated to support Aboriginal students in their efforts to achieve their goals.Do you identify yourself as an Aboriginal person of Canada, that is, First Nations, Metis, or Inuit? Yes No I prefer not to answer this questionIf you identify yourself as an Aboriginal person, are you (please check all that apply) First Nations? (Status, Non-Status, Treaty, Non-Treaty)The University considers it to be sufficient notification to mail information to the student’s address onfile; however, we may also contact you by telephone or email. Please call the Registration Centre tonotify us of changes to your contact information.viu.ca Metis? Inuit?We offer the Youth in Care Tuition Waiver Program to eligible students who have aged out of care in the British Columbia Care system as defined by the BritishColumbia Child, Family, and Community Services Act. For more information contact the Financial Aid department.Have you lived as a Youth in Care in British Columbia for 12 months or more? Yes No I prefer not to answer this questionWe would like to know if you are a “First Generation Learner.” None of my parents attended university or college Two of my parents attended university or college One of my parents attended university or college I prefer not to answer this question

Program ChoiceWhich program are you applying to?Are you applying as a visiting studenton a Letter of Permission? YesPlease indicate which VIU campus you would prefer to attend (one only). Nanaimo Powell River Parksville Qualicum Centre CowichanMonth Other Location NoPlease indicate when you would prefer to begin your classes:YearApplicants to the Bachelors of Arts, Business Administration and Science programs, please specify your intended major. The information collected is forplanning purposes only and does not guarantee access to any major.Intended Major I have not decided on a MajorEducational HistoryOfficial transcripts must be submitted from all institutions – faxed, scanned or photocopied documents are not accepted.Last High School ate Last Attended Yes NoPost-secondary Institutions AttendedLocationFromTo(year month)(year month)Did You Graduate?(year month) Yes NoApplication forProgram or CourseAdmissionOnline application available at viu.ca/applyPLEASE READ THE FOLLOWING BEFORE SIGNINGCOLLECTION, USE AND DISCLOSURE OF PERSONAL INFORMATIONThe personal information on this form is collected under the authority of the University Act (RSBC 1996, ch.468). I understand that VIU will use and maintain the informationfor the purposes of admission, registration, student support services, research, administration and reporting requirements, alumni and development, administration of theStudent Union Health and Dental plan, and other activities related to delivery of programs, courses, events and recreation by VIU. Note that in providing VIU with an emailaddress you acknowledge that VIU may send confidential information about you to this address, consistent with Section 26 of the Freedom of Information and Protectionof Privacy Act. VIU’s administration calls for creating a digital photo image of each student that is used for purposes of validating the student as a member of the VIUcommunity to gain access to campus services. The personal information will be used to verify the student Personal Education Number (PEN), required by the provinceof British Columbia, or to assign the PEN to students. The PEN is used to measure participation of the population in the post-secondary sector and for research andevaluation. For individuals admitted to a co-admission program with VIU partner institutions, I understand that all details of my application, studies, and student conductrecord will be shared openly between VIU and the partner institution. For individuals granted awards, VIU releases personal information to award donors and provincialfunding agencies. In addition, VIU uses the name of the award winners and/or photo images, municipality of residence, VIU program name, and the name or criteria of anyaward won in marketing materials for the purpose of publicizing VIU students, graduates, and their achievements. Student’s names and contact information will also beshared with the VIU Students’ Union. The use of this information will be in compliance with the Freedom of Information and Protection of Privacy Act. For questions aboutyour personal information use, you may contact VIU’s Director, Freedom of Information and Protection of Privacy at 900 Fifth Street, Nanaimo, BC, V9R 5S5, or telephone250-740-6564.APPLICANT STATEMENTI certify that all statements on the application are true and complete. I understand that misrepresentation of this information in any material way may result in cancellationof my admission or registration status. I understand that submission of this application in no way guarantees admission to a program or course, and that admission issubject to meeting Vancouver Island University Program or Course prerequisites and space availability. I agree to abide by the rules and regulations of Vancouver IslandUniversity as published in the online official Calendar, and those of the department and program in which I shall be registered, and any changes which may be made whileI am a student at the University.Registration CentresNanaimo Campus900 Fifth StreetNanaimo, BC V9R 5S5Tel: 250.740.6400Toll-free: 1.888.920.2221viu.caSignature: Date:Cowichan Campus2011 University WayDuncan, BC V9L 0C7Tel: 250.746.3500cc.viu.caParksville Qualicum Centre100 Jensen Avenue E., Box 42Parksville, BC V9P 2G3Tel: 250.248.2096viu.ca/parksvilleMatter here viu.caPowell River Campus100 - 7085 Nootka StreetPowell River, BC V8A 3C6Tel: 604.485.2878Toll-free: 1.877.888.8890pr.viu.ca

WEST Program ApplicationPlease ensure you print clearly and complete all sections of this application.Support TeamSocial/Case Worker (Name)Phone NumberOffice AddressCommunity Support Worker (Name)Phone NumberProgram/PositionIncome Source & Living ArrangementIncome Source Disability Pension Other (specify): Social Assistance Employment Assistance WCB/ICBCLiving Arrangement Family Home/With Parents Other (specify): Shared Apartment/House Live Alone Group HomeTransportationHow do you get around? BC Transit Other (specify): Personal Vehicle Handy-DartDo you have a driver’s license? Yes NoAre you familiar with this city? Yes NoVancouver Island University WEST Application Form

Legal HistoryDo you have a criminal record or any previous convictions? Yes NoIf you selected “yes,” please describe:Education HistoryWhat kinds of support did you receive at school in the past? Learning Assistance Resource Room Modified Integration IEP Teaching Assistant Skills for LifeWhat kinds of support would you need in the classroom now?Reading Level/Grade Please describe any reading or writing difficulties you have.Have you attached a copy of your last report and IEP (if applicable)? Yes NoEmployment History (describe all kinds of volunteer experience, work experience, paid employment, etc.)LocationDate StartedDate EndedDutiesReason For LeavingVancouver Island University WEST Application Form

Assessment and Treatment HistoryThe applicant is required to provide a copy of or grant permission for the release of relevant medical reports and informationfrom schools, physicians or other agencies previously involved, to assist in assessing the potential for services by the WorkplaceEssential Skills & Training Program and in making subsequent recommendations. WEST cannot take responsibility for any feesrelated to getting these reports. Please list assessments completed within the last five years.TypeBy WhomReasonDateCopy AttachedMedical Yes NoPsychological Yes NoEducational Yes NoVocational Yes NoPhysiotherapy Yes NoOccupational Therapy Yes NoVisual Yes NoAuditory Yes NoSpeech Yes NoOther RelevantAssessments Yes NoTo be Completed by WEST Application CompleteIntake Completed On: Assessment Information ReceivedDate:RecommendationsSignatureVancouver Island University WEST Application Form

Emergency InformationThis information will be used by WEST Program staff to respond to emergency situations. Information will be shared with amedical professional on in the case of an emergencyFull NamePhone NumberAddress (Unit, Street, City, Province, Postal Code)Personal Health NumberEmergency Contact (name)Phone NumberAlternate Phone NumberEmail AddressAddress (Unit, Street, City, Province, Postal Code)Disability Information (if applicable)DisabilityMedicationMajor Side Effects Seizures: Allergies:Safety IssuesStudent Medical ProtocolMedical Issue to be AddressedWarning Signs/Behaviour to Watch for/Environmental StimuliRecommended Staff ResponseAgency AffiliationContact/Social Worker/Other Support PersonPhone NumberVancouver Island University WEST Application Form

Unplanned Early Dismissal ProcedureIf we need to dismiss the students earlier than normally scheduled, what would you prefer? I am independent and can make the necessary arrangements to get home Please contact the following individual to assist me:NamePhone NumberUse of Promotional MaterialPlease check the box to give permission for student photos, testimonials and other related materials that may be used for thepromotion of the WEST Program. I give the WEST Program permission to use I DO NOT give the WEST Program permission to useThank you for taking the time to complete this form. It assists our faculty and staff to serve all our students better.Student SignatureDateParent/Support Person SignatureDate(if student is a minor)Vancouver Island University WEST Application Form

evaluation. For individuals admitted to a co-admission program with VIU partner institutions, I understand that all details of my application, studies, and student conduct record will be shared openly between VIU and the partner institution. For individuals granted awards, VIU rel

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