Fillable VSB Adult Education Intake Form (Camosun College)

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VSB Adult Education Intake Form (Camosun College)

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The VSB Adult Education Intake Form (Camosun College) form is 2 pages long and contains:

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  • 38 check-boxes
  • 34 other fields

Country of origin: CANADA
File type: PDF

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To be used for ALL students Updated: April 2020
I was under 19 years old on July 1
st
of this school year.
I have completed graduation requirements from high school.
_____________ (initial)
VSB – Adult Education Intake Form
Canadian Citizen ______ Perm. Resident ______ Convention Refugee _____ Other (Specify) __________
Please initial only one box:
I was 19 years old or older on July 1
st
of this school year.
I have completed high school graduation requirements.
_____________ (initial)
OR
Optional: Do you have Indigenous ancestry? Yes No
I have never graduated from High School.
I want to complete my BC High School diploma and I agree to follow my graduation plan.
____________ (initial)
Before coming to VSB Adult Ed, what was the last Public or Private school you attended (including high school, college or university)?
Name of School Last Grade Completed Year Attended
_____________________________________________________ _______________________________________________________
Optional: Do you have any life-threatening health conditions you would like us to be aware of? ____________________________________
Emergency Contact ________________________/_________________________/_____________________/________________________
Legal Last Name Legal First Name Phone Relationship to you
I certify that all information I gave is true and accurate to the best of my knowledge and allow the VSB to contact me as necessary:
Student Signature: ______________________________________ Date: ______________/_____________/___________
Month Day Year
Legal Last Name (Family Name) Legal First Name All Other (or Maiden) Names
Name: _________________________________________________________________________________________________________
Number & Street City Postal Code
Address: _______________________________________________________________________________________________________
Home Phone: ______________________________________ Cell Phone: ___________________________________________
(Month Day Year)
Female ____ Male ____ Birth Date: ______/______/______ Email: _________________________________
OR
Underage
Graduate
Graduated
Adult
Not
Graduated
O
ptional: Did your previous school provide you with additional/specific academic support? If so, please discuss this with the Academic
Advisor.
Checked by:__________________________________ (Print Name) PEN:___________________________ Please Order ______
Proof of Status Yes______ No______
FTE Yes______ No______ International_______ Picture ID Yes______ No______
Status verified on __________________ by _______ (init)
Document Type ____________________________________
GA______ enter Memo: “Graduated Adult; MOE Approved Courses Only” Code of Conduct Signed: Yes _____ No ____
Underage Grad Yes______ No______ Intake Centre: SL ______ GP______
AD______ 80______ Indigenous Ancestry Yes ________ No __________
New Students Only:
New Students Only:
EN/Ma Assessment Score (if applicable) RL______ ML _____ Day School Letter of Permission/WD Yes______ No______
Intake Level: School Records Attached Yes______ No______
English Foundations 1/2______ 3/4______ 5/6/7______ School Records to be ordered Yes______ No______
Academic English EN10_____ EN11______ EN12______
Advisors: PLEASE CLICK TO COMPLETE THE SECTION BELOW
CODE OF CONDUCT
PURPOSE
We believe that all members of our school deserve to be treated with dignity and respect and that diversity among our students and staff should
be welcomed and valued.
Adult Education Centres promote the values expressed in the B.C. Human Rights Code respecting the rights of all individuals in accordance with
the law, prohibiting discrimination based on race, colour, ancestry, place of origin, religion, marital status, family status, physical or mental
disability, gender identity or expression, sex or sexual orientation. Racism will not be tolerated at our school.
All students are expected to help maintain a courteous, positive and supportive learning environment. Students are also expected to
respect the health and safety of others and to avoid conduct that interferes with other students’ ability to learn.
These expectations apply to behaviour at school, during school organized or sponsored activities, and to behaviour beyond these times –
including online activities --that negatively affects learning or the safe, caring and orderly environment of the school.
EXAMPLES OF UNACCEPTABLE GENERAL BEHAVIOR:
□ any form of discrimination as prohibited in the B.C. Human Rights Code
□ damaging or stealing property of the school/building or of other students
□ possessing, using, or selling alcohol or illegal drugs or being in an intoxicated state
□ possessing or using a weapon or replica weapon
□ discriminating against, intimidating, harassing or threatening any member of the school community
□ verbally, physically or sexually assaulting another person
□ using offensive language or gestures or behaving in an inappropriate or offensive manner
□ smoking or using vapour products anywhere on school property
□ ignoring parking lot rules
□ failing to correctly identify oneself to staff
EXAMPLES OF UNACCEPTABLE ACADEMIC BEHAVIOR:
□ giving false information, or withholding information to obtain a school document or get admission to a course at the Centre
□ behaving in a way that interferes with student learning, including inappropriate cell phone use
□ using the school’s computers to conduct any illegal or inappropriate activity
Our goal is to create and maintain a safe and welcoming school community. Consequences will be designed, where possible and appropriate,
to educate and to restore a positive learning environment for everyone. The school will take all reasonable steps to prevent retaliation
against a student who has made a complaint of a breach of our code of conduct. Violations of the Code of Conduct may result in:
CONSEQUENCES OF BEHAVIOR THAT VIOLATES THE CODE OF CONDUCT:
□ cheating, plagiarizing or copying an assignment, quiz, test
oexamination
I agree to follow the Code of Conduct at each VSB Adult Education Centre I attend:
Student Signature _____________________________________________ Date ________________________________
If you have questions or concerns, please arrange a meeting with the Principal, Vice Principal, Academic Advisor or Outreach Worker. Please
note that anonymous complaints cannot be acted upon.
□ appropriate warnings
□ referrals to appropriate outside counseling
□ suspension from the Education Centre for an appropriate time period
□ suspension from all VBE Adult Learning Centres for an appropriate time period
□ expulsion from the Education Centre
□ expulsion from all VBE Adult Learning Centres
□ criminal charges
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VSB Adult Education Intake Form (Camosun College)

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Completed 4 January 2021

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