THE APPLIED CAREER TRANSITIONS ACT PROGRAM University of Victoria  Career Services ACT MODULE 2 APPLICATION FORM date mm dd yy first name street address city phone email current work status

							THE APPLIED CAREER TRANSITIONS (ACT) PROGRAM
University of Victoria  Career Services

ACT MODULE 2 APPLICATION FORM
 date (mm/dd/yy)


 first name                                            last name


 street address


 city                                      province                      postal code


 phone                                                 cell


 email


 current work status
        part-time work           full-time work       not currently working

 If currently working, do you consider your work to be…
         career-related       not career-related

 Of the dates specified on the ACT website, which Module 2 start you are applying for? (mm/dd/yy)


 Indicate which access option you are applying for. (check one only)
        coached             coached with group

 Confirm that you have completed the following Module 1 elements that are pre-requisites for
 Module 2.
       a clear articulation of your career vision and current situation
       a career portfolio that supports your career vision
       a research portfolio that supports your career vision
       submission of Module 1 post-test evaluation
       identification of 1 or 2 short-range, career-related work goals that
              have emerged as a result of your career research
              are aligned with your career vision
              are viable and realistic for you to pursue in Module 2

 NOTE - The Program Coordinators will review your file to determine if you have adequately completed
 the Module 2 pre-requisites and may contact you to request clarification or demonstration of satisfactory
 completion of these pre-requisites.
 Indicate your short-range, career-related work goals that you identified on the Emerging Career
 Goals worksheet in Module 1. These goals will indicate the type of PAID WORK OPPORTUNITIES
 you will approach organizations about in Module 2.

 WORK GOAL 1 – “I’m looking for work as a...”


 WORK GOAL 2 (optional) – “I’m looking for work as a...”




University of Victoria  Career Services
last revised 18/11/2009 19:34
THE APPLIED CAREER TRANSITIONS (ACT) PROGRAM
University of Victoria  Career Services

ACT MODULE 2 APPLICATION FORM (cont’d)
 List the TOP 10 ORGANIZATIONS that you plan to approach about this kind of work in Module 2. If
 possible, include organizations from the PRIVATE, PUBLIC and NOT-FOR-PROFIT sectors. For
 government organizations, identify each specific ministry, department or agency you plan to
 approach as a separate organization.

 1.

 2.

 3.

 4.

 5.

 6.

 7.

 8.

 9.

 10.
 Given all your current circumstances and responsibilities, are you able to commit to the ACT
 Module 2 time requirements (5 hours/week in addition to group sessions and individual coaching
 appointments)?
        YES


           Please submit this form by email to act@uvic.ca or in person to UVic Career Services.



   Thank you for your application! Once you have submitted this form, we will
contact you within one week regarding the status of your application and program
                                   availability.

 FOR OFFICE USE ONLY

      application has been reviewed and applicant has completed the following pre-requisites:
         a clear articulation of their career vision and current situation
         a career portfolio that supports their career vision
         a research portfolio that supports their career vision
         submission of Module 1 post-test evaluation
         identification of 1 or 2 short-range, career-related work goals
 Notes regarding any issues or concerns requiring clarification




      application has been approved
      applicant has been contacted regarding participation in Module 2
      applicant has responded to email request re attendance at Start-Up Session
University of Victoria  Career Services
last revised 18/11/2009 19:34