Continuing Education 1428 Gordon St. Guelph, On N1L 1C8
519-836-7280 ext. 628
Co-op @ Summer School Student Application Form
** A non-refundable $10.00 Student Service Fee is due on the first day of class.**
Application Instructions:
This application MUST be submitted by Friday, March 4, 2016 to your guidance counsellor along with two Co-op @
Summer School Teacher Reference Forms. The Co-op @ Summer School Online Application Form must also be
submitted by March 4, 2016. When you successfully complete the online form, the confirmation screen will provide a
CODE. Record the code below.
Guidance must attach the following to your application:
∙
∙
credit history/status sheet - current to mid-semester, 2016
record of attendance for the current semester
Note: All applications MUST attend an interview in April to be considered for this program. Application to the program
does not imply acceptance in to the program. Students will receive notification of acceptance following the interview
process.
Section 1 - Personal Information - PLEASE PRINT CLEARLY:
Last Name
First Name:
Middle Initial:
Home School:
Online Appliction CODE
Guidance Counsellor
Initial Required
COURSE REQUESTED:
Guidance Counsellor
(NOTE: This application will not be processed unless a suggested co-op course code is provided) Initial Required
Section 2 - Consent: (NOTE: ALL signatures are required for the application to be considered complete.
Applications with missing signatures will be returned to the home school unprocessed.)
The parent/guardian and student give permission for the release of confidential information pertaining to the student
selection process. It is understood that the Co-op Teacher and/or Board staff will endeavor to find an appropriate
apprenticeship placement for the student, but no guarantees of apprenticeship can be offered. It is understood that students
are responsible for their own transportation to and from their co-op placement.
Parent’s/Guardian’s Signature:
Student’s Signature:
Co-op Teacher Signature (if county student has discussed placement):
Counsellor’s Signature:
Date
Date
Date
Date
Status in Canada (The code number indicates the student’s status in Canada - please circle):
Canadian Citizen - 01
Permanent Resident/Landed Immigrant - 03
Other Visa - 05
Native Ancestry - 02
First Language
Student Visa - 04
Citizenship:
Refugee Status – 07
None of the Above - 06
Country/Proof of Birth:
Arrival Date:
Application Deadline Date: Fri. March 4, 2016 to your Student Services (Guidance) office.
Only those application packages that are fully completed will be considered.
Acceptance is conditional on successful completion of the related course.
This information is collected under the legal authority of the Education Act & Co-operative Education & Other Forms of Experiential Learning Policies &
Procedures Document. Users of this information will be teachers, community employers & the relevant support staff. This information will be used to
ensure that the Ministry of Education policy set out in Co-operative Education and Other Forms of Experiential Learning 2000 are met. Inquiries
should be directed to the Upper Grand Wellington Centre for Continuing Education, 1428 Gordon St. Guelph, On N1L 1C8 519-836-7280. A copy of
this form will be retained for a minimum of 1 year following completion of the course.