From: Dr Zenobia Ali- FYSci Health Sciences Camp Coordinator
RE: FYSci Health Sciences Camp Program — July 7 to July 11, 2014
Alberta Innovates – Health Solutions is pleased to offer the FYSci Health Sciences camp program to Grade 11 students currently registered in an Alberta high school. This FREE camp is designed to give
selected Grade 11 students from around the province first-hand experience of biomedical and health research, and introduce them to biomedical career opportunities. Application to this program is by teacher recommendation only.
Applicants require at least a 75% standing in each of math 20, biology 20, and one other Grade 11 science course. We require actual marks. Please submit a transcript or copy of a recent report card or progress report.
The application form will consist of one sheet verifying students’ marks, two teacher reference forms to be filled out, and a form to be filled out by the student and his/her parents acknowledging they have been recommended for the camp.
During the program, FYSci participants will attend lectures, perform hands-on science activities and go on tours of campus and other research facilities. They will also have the opportunity to discuss career and education opportunities with guest speakers. There is no charge for this camp.
The deadline for receipt of applications is May 16, 2014. Students from Red Deer and South will be eligible for the program in Calgary and students North of Red Deer will be eligible for the program in Edmonton. FYSci camp staff will go through all applications to ensure they have met all the eligibility requirements. All eligible applicants will be placed in a lottery. Twenty students will be selected for the University of Alberta camp, and twenty students will be selected for the University of Calgary camp. Depending on the number of applicants, only one student may be selected per school.
For more information, see our website at www.aihealthsolutions.ca/communications/fysci.php
Application Checklist
FYSci Health Science Camp
Submit transcripts or a copy of a recent report card or progress report verifying that the student has at least a 75% average in each of biology 20, math 20 and one other Grade 11 science. Have the student endorse and sign the application form. Have a parent or legal guardian endorse and sign the application form. Include two teacher references (science and math or other) Mail the application to the address below. The application must be postmarked by Friday, May 16, 2014 to be considered. Applications that are faxed or e-mailed
will NOT be accepted.
Mail or courier your application to:
Alberta Innovates – Health Solutions
PERSONAL INFORMATION (PLEASE PRINT IN INK) Is the student in Grade 11? c Yes c No
Male c or Female c
Last Name First Name (name used) Middle Initial
Address Date of Birth (dd/mm/yr)
City/town Postal Code
Telephone ( ) E-mail
School School Address
School Postal Code School Telephone ( ) Name of teacher recommending student
Name of other teacher reference
WHICH PROGRAM LOCATION ARE YOU APPLYING FOR? University of Alberta c
University of Calgary c
ACADEMIC BACKGROUND
Students must have at least a 75% in each of the subjects below. Please provide actual marks. Check if student has completed or is currently enrolled in:
Math 20 c Mark _______ Biology 20 c Mark _______ Other Science Course c Mark _______ Please specify: ____________________________
STUDENT CONSENT AND ACKNOWLEDGEMENT OF APPLICATION
Signature of Student Date
Return the completed form to recommending teacher.
Signature(s) of Parent/or legal guardian Date
Teacher Reference #1
(Referring Teacher)
NOTE: PLEASE USE THIS FORM ONLY.
Any accompanying letters or material on the back of this form will be disregarded.
Name of Student
Name of Teacher E-mail of Teacher
Address of Teacher
Postal Code Length of Relationship
Name of School School Address
Postal Code School Telephone ( )
What courses have you taught this student?
Please comment on the suitability of this student for this program with respect to his/her:
Strengths
Weaknesses
Why do you think this student would make a good candidate for our program?
How will this experience benefit this student?
We would appreciate any additional information regarding the questions above or any other pertinent information that would assist us in evaluating this student.
Signature Date
Teacher Reference #2
NOTE: PLEASE USE THIS FORM ONLY.
Any accompanying letters or material on the back of this form will be disregarded.
Name of Student
Name of Teacher E-mail of Teacher
Address of Teacher
Postal Code Length of Relationship
Name of School School Address
Postal Code School Telephone ( )
What courses have you taught this student?
Please comment on the suitability of this student for this program with respect to his/her:
Strengths
Weaknesses
Why do you think this student would make a good candidate for our program?
How will this experience benefit this student?
We would appreciate any additional information regarding the questions above or any other pertinent information that would assist us in evaluating this student.
Signature Date
The FYSci camp participant and his/her parent/guardian understand and
acknowledge the following:
1. The University of Alberta/Calgary and/or Alberta Innovates – Health Solutions (AIHS), the parent
organization for the FYSci Health Sciences Camp Program, does not insure personal vehicles or property for employees or participants in any of their programs. Personal property losses would have to be covered by your Personal Home Owners insurance policy. Participants who may be driving privately owned vehicles are required to ensure that the vehicle owner carries adequate insurance on the vehicle and for the participants to drive.
2. No medical/health insurance will be provided by FYSci Health Sciences Camp Program, or the
participating university. In the event of a medical/health problem, FYSci Health Sciences Camp Program and the participating university will not accept responsibility for any costs associated with a medical/health problem nor will they pay for any medical/health expenses, which may be incurred by the participant.
I understand that the FYSci Health Sciences Camp participants will be working in research
environments with people trained in first aid and safety. Therefore, participants must have up-to-date immunizations to protect their health. I also understand that FYSci Health Sciences Camp Program and University staff are not responsible for any injury, loss, or damage of any kind sustained by participants in FYSci Health Sciences Camp Program.
I acknowledge that I have read and understood this agreement. I understand and accept that any information collected about my daughter/son will be protected and used by AIHS in compliance with Alberta’s Freedom of Information and Protection of Privacy Act. I understand, appreciate, and accept the risks associated with my daughter’s/son’s participation in the FYSci Health Sciences Camp Program.
I also understand that funding for the FYSci Health Sciences Camp Program comes from AIHS, which is accountable to the people of Alberta. Therefore the participant can be named and photographed and filmed for and by the media and AIHS to promote and publicize the FYSci Program and AIHS, in printed and electronic material. I also understand the importance of acknowledging Alberta Innovates – Health Solutions (AIHS) whenever possible as the organization responsible for the FYSci Health Sciences Camp Program.
I also accept that AIHS will be tracking all FYSci Health Sciences Camp applicants over time to follow their education and careers and to gather information to continually evaluate the FYSci Health Sciences Camp Program. This will necessitate FYSci applicants replying to future AIHS correspondence and informing AIHS about new addresses and changes of name. Your signature on this form indicates your consent to receive AIHS correspondence relating to FYSci Health Sciences Camp Program evaluations as well as other AIHS program and event notices.
As the parent/guardian for the participant, I consent to my daughter’s/son’s participation in the FYSci Health Sciences Camp Program.
Signed this day of , 2014, at , Alberta. Signature of Student
