Check one of the following:

• Early Intake Applications (due date September 1st) for January-April
• Regular Intake Applications (due date October 1) forMay-August

1. NAME AND ADDRESS:

   Surname:
   Given names:
   UVic Student #:
   
   E-mail:(use uvic.ca only)
   Present address:
   
   Current Phone#:
   Permanent address:
   
   Permanent Phone#:
   Citizenship:
   Social Insurance #:

2. EDUCATION:

   Present Year of Studies:
   University: 1st year 2nd year other

   GPA: University/College (insert Grade Point Average):
   1st year    2nd year

   GPA: High School Education: (insert GPA or %):
   Grade 11  Grade 12
   Year of Graduation:
   High School:
   Location :

3. ACADEMIC PLANS: Outline undergraduate and graduate plans.
4. CAREER OBJECTIVES: Outline your future plans.

• How did you first learn about the Biology Co-op Program?
• Your resume should include details of your previous work experience (including volunteer work), and your skills, interests and activities.
• REFERENCES: At least two confidential references are required:
  (eg. a previous employer and a teacher.)
  Follow this link "REFERENCES" to submit via the internet.