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Certificate Application
APPLICATION FOR ADMISSION TO:
❏ Business and Professional Writing program
List below any courses you have previously taken from the
Writing and Publishing Program:
❏ Editing program
❏ Publishing program
Please complete this form and return with accompanying
documentation, and certificate application fee to:
Natalie Makortoff, Program Coordinator
Writing and Publishing Program
Simon Fraser University at Harbour Centre
515 West Hastings Street, Vancouver, BC V6B 5K3
Or fax to 778-782-5098
Certificate application fee of $100 per certificate is enclosed by:
(Application fees are processed only if you are accepted into a
certificate program.)
❏ cheque (made payable to Simon Fraser University)
❏ VISA ❏ MasterCard
Annual deadline to apply: November 1, 2009
cardholder’s name (if different from applicant’s)
name (first)
(initial)
(last)
account number
organization, if applicable
expiry date
signature (mandatory if paying by credit card)
title, if applicable
Collection of Personal Information
address
❏ business ❏ home ❏ other
city
province
day telephone
evening telephone
postal code
email or fax
Please submit all of the following:
❏
❏
❏
❏
letter explaining why you would like to be considered for the program
résumé, including your education and work history
at least two samples of related professional, business, or editing
portfolio pieces (10 pages maximum, total)
an explanation of the sample pieces, including how and why they
were created and an explanation of your contribution to each piece,
particularly if it was a group effort (e.g., a brochure edited by you but
designed and written by others).
The University collects your personal information under the authority of the University Act
(RSBC 1996, c. 468, s. 27(4)(a)). The information is related directly to and needed by the
University to administer and operate non-credit programs, workshops and courses. The
information will be used to register you in the appropriate non-credit program, monitor
your academic progress and send you information about University programs. It will also be
used to issue certificates and diplomas for eligible students. If you have any questions or
requests about the collection and use of this information please contact Natalie Makortoff,
Coordinator, Continuing Studies, 515 West Hastings Street, Simon Fraser University,
Vancouver, BC V6B 5K3, 778-782-5077, wpp@sfu.ca.
Personal information collected by the University for non-credit certificate and diploma
programs is also related directly to and needed by the University to administer and operate
its alumni programs and services. The information will be used to register non-credit
certificate and diploma program graduates as members of the SFU Alumni Association. This,
and other information held by the University, will be disclosed to Alumni Relations and
University Advancement in order to inform you about the benefits of University and Alumni
Association career, educational and social programs; to provide you with information about
alumni products and services; to facilitate alumni participation in university research
projects, alumni surveys and fund raising and development activities; and, to administer
elections for university and alumni association governing bodies. The University may also
disclose this information, under strict confidentiality agreements, to outside agencies solely
for the provision of mailing or telephoning services on behalf of the University or the Alumni
Association. If you have any questions or requests about the collection, use or disclosure of
this information, contact the Director of Alumni Relations, Simon Fraser University, Burnaby,
BC V5A 1S6, telephone 778-782-4154, email alumni@sfu.ca, or visit the Alumni Association
website at www.sfu.ca/alumni/.
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survey
The information obtained here is for the use of Continuing Studies only.
We do not share or make available any information to other organizations.
❏ Male
❏ Female
Education after high school, including professional training:
❏ Bachelor’s degree
_______________________________________ Major ______________________________________________________
❏ Master’s degree _________________________________________ Program of study _____________________________________________
❏ Doctoral degree
❏ Diploma
________________________________________ Program of study _____________________________________________
______________________________________________ Area ______________________________________________________
❏ Certificate _____________________________________________ Area
______________________________________________________
❏ Other courses or writing programs (please specify): _________________________________________________________________________
Age group:
❏ 19-25 ❏ 26-35 ❏ 36-45 ❏ 46-55 ❏ 56-65 ❏ 65+
What is your professional position/work? _________________________________ ________________________________________________
Your industry/organization? ______________________________________________________________________________________________
How did you first hear about the Writing and Publishing Program? ________________________________________________________________