Technical Communication Certificate Program (Online)

Student No. (if known): (9 digits, eg 554-635-321)

Email:

Last Name:

First Name:

Middle Name:

Address 1:

Address 2:

City:

Prov/State:

Country:

Postal Code/Zip Code: (eg V8A 1T1 or 32531)

Phone (Primary): (eg 604-252-3333)

Phone (Alternate): (eg 604-252-3333)

Date of Birth (mmm/dd/yyyy) Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 Male Female

Personal Profile:

Please complete the following as completely as possible:

1) Describe your work experience using computers, in particular:

a) The types of software you've used:

b) The types of hardware you are familiar with:

c) The kind of work you have done using computers:

2) Educational background:

a) List degrees, diplomas, certificates, and any other training that may be relevant.

b) List highest level of English language education achieved (eg. Grade 12, first year university, Language Proficiency Index score, English Degree, etc.)

3) What are your goals with respect to taking the Technical Communication Certificate Program? (Please give a complete answer--at least 150 words in length. Outline your work and training history, types of jobs performed, and where you think the Technical Communication Certificate will lead you in terms of enhancing your work skills and job prospects.)

Domestic students will be asked to provide application fee after clicking on the Submit button below. (International students make their application payment when they complete the International application process.) By clicking on the Submit button:

1) You certify that you have read and understood the Systems Requirements and recommended prerequisites for the courses in this program (available from www.pr.viu.ca/techcomm/software.asp#TechReq)

2) You certify that you understand that the information on this Application is subject to audit and verification (documentation may be requested).

3) You certify that the information you have given is correct and complete, and that you agree with everything written in this declaration; and

4) You give your consent to the exchange of information between Vancouver Island University and the parties you have outlined in this application to verify that the information herein is accurate.

Note: Your application fee of $35.70 CAD (domestic students) must be paid when you apply to the program. You cannot receive your certificate if there are fees owing on your student account. Apply for your certificate by completing and submitting the Certificate Request Form. International students must also complete the International Application for Admission and pay an application fee of $150 CAD.