Sheridan College Dual Credit Program Application Package 2011-2012
Animal Care Program – 2 credits revised Nov. 2, 2011
To apply for the Dual Credit Program at Sheridan, students must first complete the Registration and Consent Form,
Sheridan Statement of Understanding, Permission for Media Communications and provide to the guidance counsellor.
A complete package includes:
This page (cover)
Sheridan Registration and Consent Form
Sheridan Statement of Understanding
Permission for Media Communications
A current student status sheet
This program is delivered at the Davis campus.
THE GUIDANCE COUNSELLOR WILL PROVIDE THE INFORMATION BELOW AND FAX ALL
Student Name: ______________________________________________
School Name: _______________________________________ School Number 905-_______________
Guidance Counsellor Name: _______________________________________________ Ext ___________
The role of the 'dual credit teacher' is to monitor and support the student for the duration of the course, if different from
the 'guidance counsellor'. This teacher will have regular contact by monitoring the student’s progress at Sheridan College
and provide the programming that will supplement the dual credit program.
Dual Credit Teacher Name: ____________________________________________________Ext ___________
Please note: All correspondence related to the status of the application will be sent to the Guidance counsellor.
Upon acceptance, all correspondence related to student progress and activity will be sent to the 'Dual credit
teacher', unless otherwise notified.
Please fax completed application to:
Namita Sawh, Dual Credit office assistant, fax 905-890-3298; phone 905 890 1010 ext. 2536
Questions? email Pat Evans, Dual Credit/Experiential Learning Resource Teacher at firstname.lastname@example.org
Dual credit courses fill up quickly once course offerings for the following semester are provided to schools.
This is a semester 2 program
For semester 2 program ‘first come - first served’ until available spots are filled; preferably by December 23, 2011
FREEDOM OF INFORMATION
This information is collected under the authority of the Education Act and in compliance with Section 14, Section 32 and
Subsection 29 (1) of the Municipal Freedom of Information and Protection of Privacy Act, and will be used for the
ongoing administration of dual credit programs.
DUAL CREDIT PROGRAM REGISTRATION FORM
Animal Care program – 2 credits Davis campus
Last Name First Name
City Postal Code
Phone Home Cell
Contact to Student
Emerg. Phone Day Cell
Date of Birth dd mm yy Age Gender
Does student have an IEP ? Check Yes No
Dual Credit Teacher Phone
Semester Program Schedule Start End
2 Domestic Animal Science Mondays & Fridays Week of May 7 Week of June 22
2 Animal Grooming Mondays & Fridays Week of May 7 Week of June 22
Student Signature Date
Statement of Understanding Dual Credit Program
The Dual Credit Program offered at Sheridan College requires me to spend a considerable amount of time working and learning
outside of my home school as a college/secondary school student. I will represent my school in a responsible manner and in
accordance with my school's “Code of Conduct”.
I understand that I must follow all the rules of the Dual Credit Program.
attend regularly and be punctual both at my home school, at Sheridan College and at arranged bus pick-up locations
if absent from class, report my absence to my instructor/teacher, at both the college and secondary school, before the start of the
complete all required assignments, tasks and tests
abide by the rules of Sheridan College including appropriate behaviour and respect for persons and property; Sheridan College
expectations will be outlined within the first week of the program
following a review of Sheridan's 'Policies and Procedures Student Manual', on the first day of the program, agree to submit the
required 'Acknowledgement Form' which is at the end of the manual. This form acknowledges that I agree to listen carefully to
the instructor's review of the manual, and agree to follow all procedures outlined in that manual.
be required to provide my own safety shoes and will be required to wear other prescribed clothing for this program (e.g. personal
protective equipment), as directed by the instructor
carry my student ID with me and be prepared to present it to the bus driver and/or teachers/college instructors as requested
abide by the rules of the transportation company and act responsibly on the bus/taxi or my privileges may be withdrawn
abide by Health and Safety regulations at Sheridan College
work co-operatively and communicate in a positive manner with all instructors/teachers and peer
I understand that:
while at Sheridan College, I will be covered by the Workplace Safety and Insurance Board (WSIB). WSIB coverage is not
provided while traveling to and from the program
Sheridan instructors, coordinators, administrators and staff from Sheridan College, Peel DSB, and my secondary school may, as
required, mutually share information about my behavior, attendance and academic performance or any issues as related to the
dual credit program. Any or all information may be disclosed to parents or guardian
if I have an Individual Education Plan my teacher may discuss with my college instructor the necessary accommodations and
modifications required to allow me to be successful
if I do not use the busing provided, I will be responsible for arriving punctually at Sheridan College on the arranged dates
supervision will not be provided on the bus. The bus company can refuse service for inappropriate behaviour.
if I elect to travel as a passenger in a peer's personal or family vehicle, the district school boards/college provide no insurance
I must declare to my instructor/teacher any medical condition which may affect my participation in the program. It is strongly
recommended by the district school board/college that students obtain additional personal medical/accident insurance
I must provide my instructor/teacher with updated contact or relevant health information should there be any change in the
information I have provided
Peel DSB and Sheridan College will not be held responsible for any liability or medical expenses arising out of participating in
I understand that failure to comply with the above conditions/rules may result in my removal from the program and loss of
Student Signature Date
Parent/Guardian Signature (if student is under 18 yrs. of age) Date
One copy of this signed statement is to be retained with the secondary school, one copy is to be retained by the college, one copy to be retained by
the central board office and one copy is to be distributed to the student or, if the student is under 18 years of age, to the parent/guardian.
Permission for Media Communications
I hereby give the Peel District School Board and/or Sheridan College and its employees and agents:
(1) Permission to photograph, videotape and interview me
(2) The perpetual and non-exclusive right and licence to use my image, my name and/or a quote from
me about or a description of my involvement in a work education program in any of the media
communications (i.e. print, audio, television, social media, online) promoting dual credit and
experiential learning programs produced by or on behalf of the Peel District School Board and/or
Sheridan College without payment to me and
(3) Consent under the Freedom of Information and Protection of Privacy Act to use and disclose my
image, my name and/or a quote from me about or a description of my participation in any of the
media communications (i.e. print, audio, television, social media, online) promoting experiential
learning programs of the Peel District School Board and/or Sheridan College
I release and agree to hold harmless the Peel District School Board and/or Sheridan College, its
employees, representatives, agents and assigns, from all actions claims and demands arising from the
collection, use and disclosure of my image, my name, a quote from me or a description of my
participation in my experiential learning program in the production, reproduction or distribution of any of
the media communications mentioned above.
(if under 18 years of age)
Current Nov.1 2011