Name of School: ……..…………………………..
2012 STUDENT APPLICATION FORM (If you need extra space for added detail, please attach a separate sheet to this application form.)
Section A: to be completed by student applicant and parent/guardian Section B: to be completed by science or maths teacher Section C: to be completed by school principal CLOSING DATE FOR APPLICATIONS TO PATHWAY PLANNING OFFICER: Friday March 2 2012
Section A: Student to Complete 1. Personal details Surname: ……………………………………… Given Name(s): ……………….…………………………….…. Address: ……………………………………….……………………………...……………... Postcode………… Email Address: ………………………………………………………………… Date of birth …… / …… / …… Home Telephone No: …………..……………………… Mobile Phone No:………………………… Which college do you expect to attend in Years 11 and 12? …………..……………………… Remote Area applicants (applicants living outside the regions of Hobart, Launceston, Devonport and Burnie) Applicants may be offered the opportunity to complete 5-10 days industry placement with a mentor engineer. Most mentors are located in Hobart, Launceston, Devonport and Burnie. If you live out of these central areas, can you arrange alternate accommodation (eg. family or friends) and associated transport to do an industry placement in one of these areas? Provide details of where, number of days, and when: …………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………… Clothing Details (participants may be offered clothing provided by Engineers Australia Tasmania Division) Spray jacket (Please Circle) S M L XL 2XL
2. Your studies and interests (a) What maths and science subjects (and at what level) are you studying in Year 10? (1) …………………………………………………………………….…………………………………………… (2) …………………………………………………………………….………………….………………………... (3)…………………………………………………………………………………………………………………. (b) Outside of school studies, what other activities or interest areas are you involved in? …………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………… Futures in Engineering: Inspiring Year 10 students with authentic experiences in industry
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3. Career thoughts (a) What are your first three career interests at the moment? (If you are unsure, please say so) (1) …………………………………………………….………………………………………………….……… (2) …………………………………………………………………….………………….……………………… (3) ………………………………………………………………………………………………………………. (b) What personal qualities do you possess that could help you to succeed in your chosen career? …………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………… (c) Briefly describe what you believe is involved in engineering? …………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………… (d) What area of engineering appeals to you most? Explain why. …………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………… (e) Have you engaged in any activities or experiences that relate to the engineering profession? (e.g. MDT subjects, designed and constructed a model, dismantled and rebuilt a bike, 3D modelling on a computer etc.) Please provide details. …………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………… (f) What do you see as some of the advantages of working in engineering? …………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………
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4. Permissions and Endorsements Medical Information: Every effort will be made to contact Parent/Guardian in the case of a medical incident Known medical conditions relative to the activity: Details of any medication being taken: Allergic to: Treatment for allergic reactions: Family Doctor:
Name:
Special Diet: Parent/Guardians phone numbers:
NO YES Option 1: Option 2: Option 3:
Other emergency contact details: (relationship to student)
Name:
Phone: Details: Home /Work / Mobile Home /Work / Mobile Home /Work / Mobile Phone:
CONFIDENTIALITY NOTICE: The information contained in this application will only be used for the purpose for which it is intended. Any information used as data for research purposes will not identify individuals in any way. I consent to my child’s participation in this activity. I understand that the excursion may include activities involving some risk. I understand that if my child is selected to participate in the full Futures in Engineering program then I will need to provide transport to the associated industry placements (5-10 days during the year), which my child and I will arrange directly with the assigned mentor (supported by the Education Department). In the event of my son/daughter becoming ill or injured, I consent to the adult in charge arranging such medical or surgical treatments as deemed necessary. If necessary, in the event of injury, illness or non co-operation, I agree to pay the cost of return travel home for my child or to collect them from the excursion. I agree to reimburse the organisers for any wanton damage caused by my child. I agree to reimburse the organisers for any hospital, medical or ambulance expenses incurred on behalf of my child. Signed:
Date: (Parent/Guardian)
IMAGE PERMISSION I acknowledge and consent that photographs and video footage of my child, their activities or work samples may be published to enable others to be similarly inspired and informed. This may include, but not be restricted to, electronic publications, internet, reports, brochures, newspapers, television and letters by the Tasmanian Government or Engineers Australia. I also consent to my child being identified by their School and Given name in such use. Signed:
Date: (Parent/Guardian)
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Section B: Maths-Science Teacher/Grade Coordinator to complete Student’s Name: Please circle the most appropriate option under (a) to (e) below: (a) Has the student demonstrated interest in an engineering career? – if you cannot comment please tick here some interest
moderate interest
high level
very high level
high level
very high level
(b) How would you rate this student’s academic potential? below average
average
(c) How would you rate this student’s academic performance in maths and science subjects? below average
average
high level
very high level
high level
very high level
(d) How would you rate this student’s communication skills? below average
average
(e) Has the student demonstrated an understanding of Engineering careers and the associated educational pathways? below average
average
high level
very high level
(f) Please provide any other comments as to this student’s academic suitability, communication skills and motivation to pursue an engineering career. ……………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………… (g) How do you think involvement in the ‘Futures in Engineering’ program would benefit this student? ……………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………… Teachers name:………………………………….……………
Position:…………………….………………….
Signature: ………………….…………………………………
Telephone: …………….……………………..
Section C: School Principal to complete Please provide any additional comments regarding this student’s suitability for the initiative: ……………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………… Principal’s name: …………….…………………………………. Signature: …………….………………………..
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Background information: The Futures in Engineering (FiE) program aims to inspire Year 10 students from public schools in Tasmania to continue with maths and science studies in high school and college and to also consider engineering as a career. This is achieved by providing students with authentic and engaging experiences in engineering industries and organisations in Tasmania, both in a group and as individuals undertaking work placements (5 – 10 days) with mentor engineers. Students who participate in the program should gain an understanding of how maths and science is used in everyday life by engineering professionals and the diverse and rewarding careers that such study can lead to (particularly engineering). There are no fees associated with the FiE program or industry placements due to significant sponsorship, but any direct costs associated with participation in the industry placement (travel etc) remain the responsibility of the applicants. Selection for the FiE program is a 2-stage process: 1. Selection to attend a 1-day “Taster Day” in Burnie, Launceston or Hobart, which will include interactions with local engineers and engaging information on engineering as a career, and other fun sessions at local educational institutions. Selection for the Taster Days is based on the written application. 2. Securing one of the 32 exclusive positions in the full FiE program, which includes the group visits to UTAS (Sandy Bay) and the Australian Maritime College and 5-10 days work placement with an engineering mentor. Selection is based on the written application and informal interviews undertaken on the Taster Days. Selection for both stages is managed by staff from Guaranteeing Futures (GF) and all questions should be directed to your Pathway Planner or associated GF staff. It is preferable that all applicants attend the Taster Day but in some circumstances a personal or phone interview with the selection panel may be arranged. Note that applicants do not need to exaggerate their interest in engineering as their preferred career to perform well in selection – key elements are that they must have an interest in maths and science and be open to exploring engineering as a potential career path. The FiE program is a joint initiative of the Tasmania Division of Engineers Australia and Guaranteeing Futures (Department of Education). Significant in-kind contributions are also made by a wide range of Tasmanian engineering professionals and their employers, the University of Tasmania (School of Engineering) and the Australian Maritime College. Engineers Australia is the largest and most diverse professional body for engineers in Australia and is the national forum for the advancement of engineering and the development of engineering professionals, with almost 100,000 members embracing all disciplines of the engineering team. The Tasmania Division of Engineers Australia, in addition to providing significant sponsorship funds for the program, manages the overall FiE program and is responsible for recruiting and allocating the engineering professionals who serve as mentors. Guaranteeing Futures staff manage the selection of students and the individual placements of the students with their engineering mentors, and also arrange and supervise the Taster Days and group visits to UTAS and the AMC. The FiE program is open to Year 10 students from public schools across Tasmania, but the engineering companies and organisations who provide industry-based mentoring for the students (a key element of the program) are concentrated around Hobart, Launceston, Devonport and Burnie (with some exceptions). Applicants from more remote locations will need to undertake their placements in these regions and should indicate on the application (Section A1) if accommodation arrangements can be made to support 1 week (or preferably a total of 2 weeks) placement in one of these 4 areas.
CLOSING DATE FOR APPLICATIONS TO PATHWAY PLANNING OFFICER Friday March 2 2012 Please return applications fully completed by the closing date to your Pathway Planning Officer or by post to the contacts below for the Guaranteeing Futures team. Southern Region Lynne Hanlon VEL Development Officer Guaranteeing Futures GPO Box 169, Hobart 7001 Telephone: 0418 251 290 Lynne.P.Hanlon@education.tas.gov.au
Northern Region Linda Goss Acting Manager, VELDO Guaranteeing Futures North c/o Launceston College PO Box 2062, Launceston 7250 Telephone: 0409334459 Linda.Goss@education.tas.gov.au
North West Region Trudy Durkin Manager Guaranteeing Futures North West PO Box 1436, Burnie 7320 Telephone: 0400 803 655 Trudy.Durkin@education.tas.gov.au
FiE Application form 2012 7Feb2012
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