GDI GDI SUNTEP - Gabriel Dumont Institute · PDF file GDI GDI SUNTEP Saskatchewan Urban Native...

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Transcript of GDI GDI SUNTEP - Gabriel Dumont Institute · PDF file GDI GDI SUNTEP Saskatchewan Urban Native...

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    G D I G D I SUNTEPSUNTEP

    S a s k a t c h e w a n U r b a n N a t i v e S a s k a t c h e w a n U r b a n N a t i v e T e a c h e r E d u c a t i o n P r o g r a mT e a c h e r E d u c a t i o n P r o g r a m S t u d e n t A p p l i c a t i o n F o r mS t u d e n t A p p l i c a t i o n F o r m

    ( D e a d l i n e ( D e a d l i n e –– M a y 1M a y 1 s ts t ))

    LAST NAME: _________________________ GIVEN NAME(S) ________________________ SOCIAL INSURANCE #: ____________________ HOSPITALIZATION # _________________ BIRTHDATE: ____ / _____ /____ Mo Day Yr MALE: _____ FEMALE: _____ Single: ______ Married: ______ Other: _________________ List Dependents and ages: ______ _____ PERMANENT ADDRESS: Street Address: _________________________________________ City: __________________ Province: _______________ Postal Code _________________ Phone #: _________________ Email address : __________________________________ Work Phone # ________________ Cell Phone # _________________ MAILING ADDRESS: (if different from permanent address) Street Address: _________________________________________ City: __________________ Province: ________________ Postal Code __________________ Phone #: _______________ NEXT OF KIN: Name: ___________________________________ Relationship: ________________________ Street Address: _______________________________________ City: ____________________

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    Province: ________________ Postal Code ___________________ Phone #: ______________ PLEASE INDICATE IF YOU ARE: Métis - MNS (Name and Number) ____________________ Non-Status (Home Community) _______________ First Nations (Band Affiliation) ______________________ Other: _________________________________________ ABORIGINAL LANGUAGE(S) SPOKEN: Cree ___ Saulteaux ___ Dene ____ Nakota ____ Dakota ___ Michif ___ Other _____________ Specify EDUCATION: (Please include prior University attendance) Name of School Location Dates Attended Grade/Course ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ EMPLOYMENT: Employer Name Location Dates Position ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________

    REFERENCES: Name Address Occupation Phone No. ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________

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    FINANCES: How do you plan to finance yourself while attending this program? ___________________ ________________________________________________________________________ Have you taken out student loans before? _______ If yes, what program were you taking at the time? _________________________________ EMPLOYMENT HISTORY: Are you currently employed? ____ For how long? _________ Job type? __________________ Are you unemployed? _____ On Employment benefits? _____ If you are unemployed or on unemployment insurance, please indicate for how long. 24 weeks or more ________ less than 24 weeks ___________ PLEASE INDICATE YOUR 1ST AND 2ND CHOICE OF CENTRE LOCATIONS Regina _______ Saskatoon _______ Prince Albert ________ Reason: ____________________________________________________________________________ Are you willing to relocate if not accepted at first choice? ____________ The following documents MUST be submitted with your application: 1. A one page handwritten statement indicating your reasons for applying and your interest in a

    professional teacher education training program. 2. Three letters of reference: a) one from your Metis local or Funding Agency b) one from an instructor or principal of the last educational institute you attended c) one from someone who knows you very well 3. A transcript of your grades from the last high school and/or post-secondary institution you

    have attended. 4. A policy regarding Criminal Record Checks (CRC) has recently been implemented by many

    school divisions in Saskatchewan. The policy requires that anyone participating in a school activity on a regular basis must provide a current original CRC, which must include a VULNERABLE SECTOR SEARCH, to the school division before they are allowed into the school.

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    DROP OFF, MAIL OR FAX YOUR APPLICATION & SUPPORTING DOCUMENTS TO THE CENTRE OF YOUR CHOICE: SUNTEP Regina Rm 227, College West University of Regina 3737 Wascana Parkway Regina, SK S4S 0A2 Phone: (306) 347-4110 Fax: (306) 347-4119

    SUNTEP, Saskatoon Rm 7, McLean Hall 106 Wiggins Rd University of Saskatchewan Saskatoon, SK S7N 5E6 Phone: (306) 975-7095 Fax: (306) 975-1108

    SUNTEP, Prince Albert 48 – 12th Street East Prince Albert, SK S6V 1B2 Phone: (306) 764-1797 Fax: (306) 764-3995

    How did you hear about SUNTEP? _____________________________________________________________________ Do you know anyone in the program? _____________________________________________________________________ When you imagine yourself as a teacher in the classroom, what is the approximate age of the students you are working with? _____________________________________________________________________ I hereby certify that all of the information provided on this form is true and accurate. DATE: ________________ SIGNATURE: _______________________________ FOR FURTHER INFORMATION, please contact the SUNTEP office of your choice.

    All information contained on this application form will be shared with the selection committee and will be kept confidential.