APPLICATION FOR ADMISSION Career Development Practitioner Certificate Program 5 TH Intake (CDPC)

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1 APPLICATION FOR ADMISSION Career Development Practitioner Certificate Program 5 TH Intake (CDPC) ADMISSION REQUIREMENTS To qualify for admission, applicants must: Be a graduate of a Canadian High School (or hold a Senior Level 4 or Manitoba Grade 12 or equivalent including GED) Documentation required - Must provide original high school transcript (that indicates grade 12 requirements were met) or original high school diploma If not a High School graduate, must be 19 years of age or older and have completed at least ONE of the following conditions: o Two years of related work experience verified by the employer Documentation required - Must provide original letter verifying employment o o Two 40S or 300 level high school courses within the last three years Documentation required - Must provide original transcript 90 hours of course work at a post-secondary institution with final grade of C+ or better Documentation required - Must provide original transcript PERSONAL INFORMATION (Please print clearly) Student ID #: Last Name First Name Middle Name Gender: Female Male Home Address Date of Birth (MM/DD/YYYY) City, Province Postal Code Address Home Phone Cell Phone Business Phone Employer Job Title All applicants must answers the following questions: 1. Are you a new student at the University of Winnipeg, Professional, Applied and Continuing Education? Yes No 2. Have you ever registered or are you registered at University of Winnipeg in degree-credit studies? Yes No 3. Have you ever registered or are you currently registered at another post-secondary institution? Yes No TEL: (204) pace.uwinnipegcourses.ca FAX: (204)

2 CDPC Application for Admission 2 TUITION Tuition for this program is $4,800. Full payment of the program is due September 1, Payment instalments can also be made, with the following prescribed payment deadlines: Non-refundable deposit - $400 Due at time of registration Instalment 1 - $1,100: Due by September 1, 2014 Instalment 2 - $1,100: Due by November 1, 2014 Instalment 3 - $1,100: Due by January 1, 2015 Instalment 4 - $1,100: Due by March 1, 2015 Students must make arrangements for their tuition payments before the start of the program, or will lose their secured seat if they are unable to secure financing. Please Note: No Alumni discount can be applied to this program Seats in this program are non-transferrable Non-refundable Registration Deposit Students must provide a non-refundable registration deposit of $400 at the time of registration to secure a seat in the Career Development Practitioner Certificate Program. This deposit can be made via cash, cheque, or authorization to invoice from sponsor. The deadline for payment of the registration deposit is September 1, 2014, in order for applicants to retain a secure seat in the program. Applicants expecting tuition sponsorship though a government sponsored agency or student loan program, must still pay the registration deposit by the prescribed deadline. FOR OFFICE USE ONLY Deposit $ or attach Authorization to invoice Method of Payment (circle one) DEBIT CASH MC VISA CHEQUE Receipt Number Processed By Date Processed Documentation Enclosed 1. High School Transcript One of 2. Documentation Enclosed 2. a Employment Verification Letter One of 2. Documentation Enclosed 2. b High School Transcript 40S or 300) One of 2. Documentation Enclosed 2. c College or University transcript (90 CH)

3 CDPC Application for Admission 3 * International students will be considered for admission to the CDPC program on an individual basis. The University reserves the right to set a level of academic proficiency to determine acceptance. Proficiency in basic computing skills is required for this program. PRIMARY LANGUAGE (primary language refers to your first language) The language of instruction at the university is English. You must have a level of ability in English that allows you to participate in all aspects of university study, including lectures, reading, writing, and discussion. If English is not your first/primary language and you are not from an English Exempt Country, you must provide supporting documentation to show you meet the requirement. Given the options, please select the one that best describes you: English Language Test (i.e. TOEFL or IELTS) A minimum overall IELTS band score of 6.5 and a minimum of 6.0 in the Writing and Reading categories. A minimum TOEFL score of 80 (internet based) and a minimum or 21 for the Writing and Reading categories. Successful completion of Academic Level 5 at the English Language Program CanTEST Ten consecutive years of residency in Canada (may include years of study in Canada) Three years of full-time education in English at secondary (high school) or post-secondary (university or college) levels in Canada Graduation from a Canadian high school with at least one Grade 12 Core/Focus English with a minimum grade of 70% Achieved a minimum grade of four (B) on the International Baccalaureate Higher Level English course, or a minimum grade of three (B) on the Advanced Placement English examination (Language Composition; Literature and Composition) Graduation from a Canadian curriculum high school outside of Canada with at least one Grade 12 English with a minimum grade of 75% I am from an English Exempt Country I have not met the English Proficiency Requirement Note: The University reserves the right to request additional documentation, which may include the submission of a standardized test of English. English language tests older than two years will not be considered. Please provide a copy of the official results for verification purposes.

4 CDPC Application for Admission 4 EDUCATIONAL EXPERIENCE (List most recent first) Institution Program Degree/Diploma/Certificate or highest grade achieved WORK EXPERIENCE (List most recent first) Name of Employer Position Held Years If outside of Canada, please specify city and country for above jobs: Briefly describe your current professional responsibilities: Prior Learning (self-study, volunteer, professional training) related to this program area:

5 CDPC Application for Admission 5 PROFESSIONAL DESIGNATIONS OBTAINED Professional Designation Date Professional Designation Date What do you hope to gain/achieve through this Diploma or Certificate Program? ACCESSIBILITY Accessibility Services assists with confidential academic accommodation and support plans for students who identify themselves as having a disability or temporary health condition. For more information, call Accessibility Services at (204)779-UWIN (8946). [ ] contact me about supports available in Accessibility Services ABORIGINAL ANCESTRY The Aboriginal Student Services Centre (ASSC) offers services, events and information on sources of funding that may be of interest to you. By declaring your status, you will help in the development of new services and events for First Nations, Metis and Inuit students: If you are of Aboriginal ancestry, please specify (Self-declaration is voluntary): [ ] First Nations (status) [ ] Inuit [ ] Aboriginal/Indigenous [ ] First Nations (non-status) [ ] Metis SUPPORTING DOCUMENTATION CHECKLIST Applicants are required to submit all supporting documentation with their application (as per the list below). Official transcripts Proof of name change, if a different name is on any supporting documents Note: All supporting documents become property of UWinnipeg and will not be returned.

6 CDPC Application for Admission 6 CDPC PROGRAM REFUND POLICY Students withdrawing from this program prior to the fixed end-date due to extenuating circumstances will incur an early withdrawal penalty of $1,000 for each month of study. This penalty is charged by the University and withheld directly from the subsequent refund. To be eligible for a refund, students must submit a letter outlining their reasons for early withdrawal with the appropriate documentation within 10 days of withdrawal. The University will not consider scheduling changes or level of academic commitment as grounds for early withdrawal. Students should notify any funding agents of their voluntary withdrawal and discuss the funding implications of this decision. Students are responsible for any outstanding tuition in the event that a sponsor terminates funding for any reason, even in the case of a voluntary withdrawal. Refunds will be pro-rated on the following basis: More than 7 Days Prior to Program Start Date - Full refund less $700 + non-refundable registration deposit (total $1,100) Less than 30 Days of Study - The full program fee with the following deductions: $1,000 early withdrawal penalty + non-refundable registration deposit + direct costs (i.e., tuition, books, materials, etc.) Between Days of Study - The full program fee with the following deductions: $2,000 early withdrawal penalty + non-refundable registration deposit + direct costs (i.e., tuition, books, materials, etc.) Between Days of Study - The full program fee with the following deductions: $3,000 early withdrawal penalty + non-refundable registration deposit + direct costs (i.e., tuition, books, materials, etc.) Between Days of Study - The full program fee with the following deductions: $4,000 early withdrawal penalty + non-refundable registration deposit + direct costs (i.e., tuition, books, materials, etc.) More than 121 Days of Study - Students will forfeit the right to a refund after this date. NON-REFUNDABLE TRANSFER POLICY A non-refundable transfer letter may be requested when extenuating circumstances such as documented illness or severe personal difficulties result in absenteeism that exceeds the minimum attendance requirement. This application form must be submitted to the UWPACE Registration Office no more than five (5) working days after the date on which a student falls below the minimum attendance requirement for an individual course. Non-refundable transfer letters are subject to some registration conditions. Textbook purchases for subsequent courses are the student s responsibility. DECLARATION Please read the following information carefully. This declaration must be signed and dated before your application can be submitted. All relevant information (including previous post-secondary education), supporting documentation, and the non-refundable registration deposit must be submitted with this application. Registration at a post-secondary institution subsequent to the submission of this application must be declared in writing. I declare that I have read and understood the information on this application, and that all statements made with respect to this application are true and complete. I agree, if admitted, to comply with the regulations of the University of Winnipeg. I consent to the disclosure of information on this application to other educational institutions to verify my statements and academic qualifications. I understand that misrepresentation, falsification of documents, or the withholding of requested information with respect to this application may result in cancellation of the acceptance and registration, or dismissal from the University. I accept that information on falsified documents may be shared with the Association of Registrars of the University and Colleges of Canada. I authorize my high school/university to release my academic record should the need arise to accelerate the acceptance of this application. Date: Signature of Applicant: Freedom of Information and Protection of Privacy Act Clause The University of Winnipeg will use the personal information collected on this form for registration, accounting and correspondence purposes related to fee payment only. It is collected under the general authority of the University of Winnipeg Act, in conformity with, and protected under, the Manitoba Freedom of Information and Protection of Privacy Act. Elements of your personal information may also be provided to program staff to inform you of program and community events, and to Advancement Services/University of Winnipeg Foundation for alumni contact purposes. Finally, personal information may be used to conduct research into program enrolment and related statistical profiling activities. If you have any questions about the collection and use of this information please Krista Krueger, the PACE FIPPA Contact at k.krueger@uwinnipeg.ca.

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