HAVE YOU ATTENDED OR APPLIED TO CAMOSUN BEFORE

2015 - 2016
COURSE APPLICATION PACKAGE
Revised June 2015
Submit to your Secondary School
Career Education Contact or Coordinator
SOUTH ISLAND PARTNERSHIP COURSE APPLICATION INFORMATION
GETTING STARTED
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
Students and parents meet with a school career coordinator/counsellor to discuss SIP course options.

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 course.

Students should not take a post-secondary course unless they are prepared to attend all classes and complete all
required assignments.

Withdrawal Process: If for any reason you are not able to fully participate in the post-secondary course (attend all
classes and complete all required assignments), you may withdraw from the course without academic penalty prior
to completion of 66% of the course. Please inform your Camosun instructor, the SIP office (250-370-4208), and your
school career coordinator/counsellor of your withdrawal 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).
Visit our website: camosun.ca/learn/south-island-partnership. Questions can be directed to your school career
coordinator/counsellor or the SIP office (250-370-4208, email [email protected]).
HOW TO APPLY (please complete all forms in ink)
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
See your school career coordinator/counsellor for assistance completing this package.
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Students are accepted based on meeting qualifications and date of application received in the SIP office.
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).
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
 Completed and signed Student Education/Transition Plan
 Transcript of marks for the last completed year, including grades ten and eleven
 Teacher Recommendation Form, where applicable
 Completed and signed Sponsorship Form, where applicable
 English Assessment, where applicable
NOTES:
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Incomplete applications will be returned to the high school, unprocessed.
Tuition fees will be paid by your school district if a completed and signed sponsorship form is provided.
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 course. Apply for a college transcript to receive your report.
http://camosun.ca/services/_documents/transcript-request.pdf
Course Acceptance Disclaimer: These courses 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?
South Island Partnership
Camosun College
4461 Interurban Road
Victoria BC V9E 2C1
 Yes
If yes, what is your
Camosun College
Student Number?
250-370-4208 [email protected]
No
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
M M
D D
Y Y Y Y
___ ___ / ___ ___ / ___ ___ ___ ___
GENDER
Male
*Providing your SIN helps us to ensure the
accuracy and completeness of your transcript and
your tuition tax receipt.
SOCIAL INSURANCE NUMBER (optional*)
Female
___ ___ ___ - ___ ___ ___ - ___ ___ ___
CONTACT INFORMATION
MAILING ADDRESS
CITY
STUDENT HOME TELEPHONE NUMBER
PROVINCE
STUDENT CELL PHONE NUMBER
________ - ________ - ____________
POSTAL CODE
STUDENT EMAIL
________ - ________ - ____________
PARENT/GUARDIAN NAME
PARENT/GUARDIAN PHONE NUMBER
PARENT EMAIL
________ - ________ - ____________
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
COURSE LOCATION
COURSE
COURSE LOCATION
COURSE START DATE
___ ___ / ___ ___ ___ ___
COURSE START DATE
___ ___ / ___ ___ ___ ___
COURSE START DATE
___ ___ / ___ ___ ___ ___
COURSE
COURSE LOCATION
COURSE START DATE
___ ___ / ___ ___ ___ ___
SECONDARY SCHOOL (HIGH SCHOOL) INFORMATION
BC Personal Education Number (PEN) if known
___
___
___
___
SECONDARY SCHOOL NAME
___
___
___
GRADE CURRENTLY ENROLLED IN
___
EXPECTED GRADUATION DATE
M
M
___ ___
___
SD #
TEACHER / COUNSELLOR NAME (please print):
APPROVAL (signature):
Y Y Y Y
/ ___ ___ ___ ___
DATE
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)
If Yes, are you
First Nations Status
Yes
First Nations Non-Status
No
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)
TUITION FEE
(Credit card and cash will not be accepted)
(Cash will not be accepted) $38.64
Invoice School District __________
Cheque or Money Order (attach) Payable to Camosun College
Visa
Mastercard
American Express
Card No: _________ _________ _________ _________
Expiry ____ / ____
MM YY
Name of Card Holder:
JCB
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
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)
Camosun Student #: C (Office Use Only)
____________________________________
First Name (please print)
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 [email protected]
RESPONSIBILITY AGREEMENT - COURSES
High School/School District, SIP, and Camosun Responsibilities
We will:
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provide tuition funding (NB: students are responsible for the application fee)
inform you of the requirements specific to your course(s) 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 8 or more weeks prior to the start
of your course(s)
work with SIP to ensure you are enrolled in your course(s)
provide you with student support services as needed (assessment, learning skills, math upgrading, counselling,
disability resources)
encourage you to be proactive in informing the Disability Resource Centre of your specific learning needs and IEPs
(make an appointment with our DRC by calling 250-370-4049)
liaise with your parents, high school 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:
ensure that I have met all prerequisites
submit a completed application package and the application fee to my school career counsellor at least 8 weeks
before the start of my course(s)
 I understand that without a completed and submitted application, I will not have access to the D2L (online)
component of my course(s)
 contact a post-secondary academic advisor if I am taking more than two Dual Credit courses
 purchase required text books, support materials, equipment, and clothing
be prepared for the rigors of a first year post-secondary course which include:


a commitment to matching course hours with home study
high standards in writing competency and attention to detail in written assignments
contact my instructor if I will be absent or late; I understand that punctuality and attendance are mandatory
requirements of Camosun College

inform my Camosun instructor, my school counsellor, and the SIP office (250-370-4208) if I drop a course.
Dropping a course only happens before the end of the second week of course start up without financial or academic penalty.
inform my Camosun instructor, my school counsellor, and the SIP office of withdrawal from my course(s)


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Failure to withdraw in advance of 66% of course 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)
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
Student Name (please print clearly): ______________________________________
Date: _________________________
Student Signature: __________________________________________________ High School: _______________________
Parent/Guardian Name (please print clearly): _______________________________________________________________
Parent/Guardian Signature: _____________________________________________

Date: _________________________
Career Counsellor Name (please print clearly): _____________________________________
STUDENT EDUCATION/TRANSITION PLAN
Develop your Education/Transition Plan. Include courses required for entry into the program you will participate in while attending Camosun College or another postsecondary institution.
Name: _________________________________________________
1.
2.
3.
4.
5.
High School: ____________________________
Date: _______________________________
Ensure you have included and considered your graduation requirements in your Education/Transition Plan.
You may need to modify your timeline to achieve your graduation requirements & participate in the program.
Complete the 3-Year Education/Transition Plan in full, beginning with your Grade 10 courses.
Timetable changes should be made with the approval of your school’s Career Coordinator/Counsellor.
Include any Dual Credits and SSA Credits in your predicted credit count.
Students are required to complete a minimum of 80 credits (equivalent to 20 four-credit courses) in Grades 10 –
12 for graduation. Most students choose to complete more than 80 credits.
1. Required Courses - 52 credits in courses listed below:
Course
Credits
Course
Credits
English 10
4
English 11
4
Fine Arts or Applied Skills 10, 11, 12
4
Social Studies 11, Civics 11, First Nations 12
4
Science 10
4
Mathematics 11 or 12
4
Mathematics 10
4
Science 11 or 12
4
Physical Education 10
4
English 12 or English First Peoples
4
Planning 10
4
* Graduation Transitions 12
4
Social Studies 10
4
Note: Graduation = Minimum 4 Grade 12 level courses + * Graduation Transitions 12
Year
Year
Gr 10
Sem 1
Gr 10
Sem 2
Total Credits:
available)
Transition Program:
____________________________________________________
Year
Gr 11
Sem 1
Gr 11
Sem 2
Total Credits:
Total Credits Predicted (Required + Elective) =
2. Elective Courses – 28 credits
Students can choose to complete elective
requirements through the South Island
Partnership – Dual Credit Programs/Courses
(PSIB Credits) and/or
Secondary School Apprenticeship Program
(SSA Credits=SSA 11A, 11B, 12A, 12B,
Gr 12
Sem 1
Gr 12
Sem 2
Total Credits:
Year
Transition Program/Course(s)
Sem 1
Sem 2
Total Credits:
Predicted Graduation Date:
Teacher/Counsellor (Print Name)
___________________________________
Parent/Guardian (Print Name)
_______________________________________________
Teacher/Counsellor (Signature)
____________________________________________
Parent/Guardian (Signature)
______________________________________
Student Signature
_____________________________________________
TEACHER /COUNSELLOR RECOMMENDATION FORM
PLEASE NOTE:
If the English 12 requirement has not been met or English 12 is not being taken
concurrently, then the English assessment must be taken.
See the Assessment Centre - http://camosun.ca/services/assessment-centre/ for more information
This form is required for ALL students who have not completed co-requisites.
Provide a separate Recommendation Form for each co-requisite.
TEAC applicants DO NOT complete this page.
For more information regarding pre or co-requisites, assessment, or group sponsorship forms,
please contact the SIP office – 250-370-4208 or email [email protected]
Student name: ______________________________________________________________
Camosun College course applied for: ____________________________________________
Prerequisite/co-requisite needed: _______________________________________________
The student is projected to achieve a final grade/percent of _______________ in ________________________.
Skills Assessment - Please rate the student on the following areas as follows:
1) Excellent
2) Good
*3) Average *4) Needs Improvement
*5) Not ready at this time
Writing Skills
__________
Work Ethic
__________
Reading Skills
__________
Numeracy Skills __________
Please comment on student readiness for post-secondary learning. (Comments required for *3, *4, *5)
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
_______________________________
________________________________
___________________
Teacher/Counsellor Name
Teacher/ Counsellor Signature
Date (day/month/year)