UP 2019 Fall Program Application Form Steps on how to apply – click here Apply for Fall 2019 Student Application Procedure REQUIRED DOCUMENTS: One set of transcripts for all post-secondary academic activities (official or unofficial). A brief statement of interest (max 300 words submitted as PDF) explaining the appropriateness of the requested course(s) to your own professional development. If you are applying for more than one course, you may choose to submit a customized statement for each. Course specific additional documentation, if applicable (listed below). You will be notified by e-mail when your application is complete. Questions may be directed to University Programs Email:firstname.lastname@example.org Phone: 250-728-3301 Ext 216 The Director of BMSC has final authority in accepting students for courses. On-line Application Form Fall Application Deadline: March 31, 2019 Student applications received past the application deadline will be assessed on a first-come, first-served basis Attachments (please attach all in PDF format) Statement of Interest Transcripts (Optional) Additional Transcript File 1 (Optional) Additional Transcript File 2 Letter of accommodation (for students with learning disabilites) Doctor's note for students with food allergies/diet restictions Applicant information *Required field Prefix *First name *Last name Nickname *Date of birth (Format YYYY-MM-DD) Permanent Address Please use an address where you can receive BMSC communications for the foreseeable future *Street Address Street Address line 2 Street Address line 3 *City *Province/State -----CANADA--AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Territory--UNITEDSTATES--AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDistrict of ColumbiaDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming--AUSTRALIA--Australian Capital TerritoryNew South WalesNorthern TerritoryQueenslandSouth AustraliaTasmaniaVictoriaWestern Australia *Postal/Zip Code *Country ---CanadaUnited StatesUnited Kingdom-----AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArmeniaArubaAustraliaAustriaAzerbaijanAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaireBosnia and HerzegovinaBotswanaBouvet Island (Bouvetoya)BrazilBritish Indian Ocean Territory (Chagos Archipelago)British Virgin IslandsBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCuraçaoCyprusCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly See (Vatican City State)HondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKazakhstanKenyaKiribatiKoreaKoreaKuwaitKyrgyz RepublicLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyan Arab JamahiriyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Netherlands)Slovakia (Slovak Republic)SloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia & S. Sandwich IslandsSpainSri LankaSudanSurinameSvalbard & Jan Mayen IslandsSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkeyTurkmenistanTurks and Caicos IslandsTuvaluU.S. Virgin IslandsU.S. Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUruguayUzbekistanVanuatuVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabwe Contact info *Phone Number (Format: XXX-XXX-XXXX) *Email *Must be able to receive attachments Alternate Email Emergency Contact *Name *Phone Number (Format: XXX-XXX-XXXX) Further information *Member university you attend - Students from Non-member universities, please select "University of Victoria" ---AuditUniversity of AlbertaUniversity of Alberta - Augustana CampusUniversity of CalgaryUniversity of British ColumbiaUniversity of British Columbia - Okanagan CampusSimon Fraser UniversityUniversity of Victoria Non-member university you attend *Student ID number *Academic standing as of May 1st, 2018 (If you have completed your second undergraduate year, you are considered a third year undergraduate) ---High School Graduate1st yr Undergraduate2nd yr Undergraduate3rd yr Undergraduate4th yr Undergraduate5th yr UndergraduateBA/BSc GraduateMasters StudentMasters GraduatePhD StudentPhD GraduatePost Doctoral FellowOther *Field of study, including major *Please calculate and report your rGPA here (your GPA based on your most recent 20 courses). If you do not have 20 courses yet, report your cGPA based on all of the courses you have taken. Please report your rGPA OUT OF the highest level GPA for your institution (e.g. 2.7 out of 4.0 for UAlberta or 7.8 out of 9.0 for Uvic or 3.0 out of 4.33 for SFU etc.). *Have you been to BMSC before? Please select all that apply No, I have not been to BMSC before Yes, Elementary or High School field trip Yes, University field trip Yes, Other educational or group field trip Yes, Previous BMSC summer or fall university course(s) Yes, Research/Research assistant If past trip selected above, please select year ---2018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994 Please name the school you came with, and/or courses attended at BMSC *How did you learn about BMSC? BMSC Website Instructor at home university Academic advisor at home university BMSC Ambassador at home university Poster at home university Digital display at home university Former/current BMSC student Social Media (Facebook share or post by friend) Other (please specify below) Reference Information *Name of professor who will recommend you *University *Phone *Email Recommended or Required Courses If you are currently taking a prerequisite course, select 'TBD'. Prerequisites University? Course Title Course Code Grade Ecology (REQUIRED) N/ANoA+AA-B+BB-C+CC-DFTBD Statistics (REQUIRED) N/ANoA+AA-B+BB-C+CC-DFTBD Invertebrate Biology (Recommended) N/ANoA+AA-B+BB-C+CC-DFTBD Non-Vascular Plants (Recommended) N/ANoA+AA-B+BB-C+CC-DFTBD Boat Use University Program students are given the opportunity to operate a 14ft outboard boat as part of their courses at BMSC. All boat operators must have the following before coming to BMSC: Pleasure Craft Operator's Card (PCOC); and Two-day First Aid certificate recognized by a province or territory (e.g. Red Cross, St. John’s)(see here) Boating experience is recommended but not necessary; training is provided on the first day of class. Students will be given the opportunity to practice their skills prior to being given permission to take the boats outside the inlet. Do you wish to operate boats? If not, please skip next 2 sections YesNo I would like to operate boats and presently have the necessary certifications YesNo I will obtain a PCOC and the necessary First Aid certification prior to arriving at BMSC YesNo PCOC number First Aid certification First Aid expiry date SCUBA If you intend to dive at BMSC, please consult the BMSC website on qualifying as a Scientific Diver at BMSC. The following list of equipment is REQUIRED. If you cannot fulfill this list, please explain your situation in the text box below. Mask, snorkel, fins Dry suit (MANDATORY) Hood, boots, gloves Weight system Buoyancy compensator with low pressure inflator Regulator Alternate air source Submersible pressure gauge Underwater compass Bottom timer (i.e. dive watch) Primary dive light Back-up dive light Dive knife TWO emergency signal devices - one audible, one visual Small gear bag (i.e. mesh goody bag) Logbook (minimum 12 dives in 12 months prior to arrival) NOTE: BMSC will supply you with SCUBA tanks Do you plan to use SCUBA? YesNo Will you be able to bring all of the equipment listed? YesNo Scuba Equipment special notes Please explain your circumstances if you were unable to answer 'Yes' above Accomodation Note: Students will be housed in a co-ed dormitory in shared, same-gender rooms. *Gender (for housing assignment) ---FemaleMaleNon-BinaryOther Housing comments (e.g. name of preferred roommate etc.): *Dietary preferences Meals always include a meat option and a vegetarian option. To help us determine how much food to order and prepare, please indicate your preferences below. If you indicate that you eat meat, you will be expected to take the meat option for all meals. You can change this option at a later time. *Dietary Preferences ---Meat optionVegetarian OptionVegan Option BMSC is equipped to accommodate vegetarian/vegan diets. Due to the high number of dietary restrictions received from students in recent years, specific dietary restrictions should be accompanied by a note from a doctor. An example of an exception: if you eat meat but can not eat pork (e.g. for religious reasons), please mention that here. List all dietary sensitivities or allergies: Pertinent Medical Conditions Bamfield is remote. It has a clinic with a small medical dispensary, staffed by a nurse. The closest doctor and hospital are in Port Alberni, two hours away by road. In the event of an emergency, evacuations by boat/helicopter are possible and dependent on weather. For these reasons, BMSC takes its students’ medical conditions very seriously. Please share any pertinent, pre-existing medical conditions. This information is treated as confidential and will not be considered during the application process; it will be disclosed to BMSC First Aid officers and instructional staff during your course. The type of information we need includes but is not limited to: Serious allergies, diabetes, epilepsy, mobility issues, hearing impairments, issues with balance, visual impairments, pre-existing injuries, recent surgeries, serious illnesses, and mental health illness.