SSEP Application Part 1: Student Section SECTION 1: APPLICANT INFORMATION Applicant Name: Email Address: Mailing Address: Best phone to reach you: Date of Birth (mm/dd/yyyy): Name of High School: MCP and SIN - Please note that upon hiring an MCP number and Social Insurance Number (SIN) will be required from successful applicants. Students who do not have a SIN upon notification of acceptance will not be accepted. Please do not include them on this application. Are you a resident of Canada? YesNo What grade level are you currently completing? Level 2 (Grade 11)Level 1 (Grade 10) - Labrador students only So you have any health concerns or other information we should know about? (I.e. allergies, medical requirements) OPTIONAL Your answers, or your choice to leave this question unanswered, will have no effect on your application. Please check any that apply to you. IndigenousVisible Minority SECTION 2: APPLICANT INTERESTS What are your educational and career aspirations for the future? Please indicate the subjects you are most interested in: Fisheries: —Please choose an option—Very InterestedSomewhat InterestedNot Interested Forestry: —Please choose an option—Very InterestedSomewhat InterestedNot Interested Ecology: —Please choose an option—Very InterestedSomewhat InterestedNot Interested Geology: —Please choose an option—Very InterestedSomewhat InterestedNot Interested Geography: —Please choose an option—Very InterestedSomewhat InterestedNot Interested Physics: —Please choose an option—Very InterestedSomewhat InterestedNot Interested Chemistry: —Please choose an option—Very InterestedSomewhat InterestedNot Interested Biology: —Please choose an option—Very InterestedSomewhat InterestedNot Interested Mathematics: —Please choose an option—Very InterestedSomewhat InterestedNot Interested Engineering: —Please choose an option—Very InterestedSomewhat InterestedNot Interested Medicine: —Please choose an option—Very InterestedSomewhat InterestedNot Interested Education: —Please choose an option—Very InterestedSomewhat InterestedNot Interested Community Outreach: —Please choose an option—Very InterestedSomewhat InterestedNot Interested SECTION 3: PERSONAL STATEMENT The Personal Statement will help us to understand why you think a WISE Student Summer Research Placement would be of benefit to you and your future career goals. This Statement should be a maximum of two pages. Include your interests, groups and activities you may be involved in and why they may be relevant to your application for WISE SSEP. This statement is an important part in the assessment of your application so show us your enthusiasm and personality! You may handwrite or type your statement. Insert statement here SECTION 4: JOB PLACEMENT SELECTION Job Placement Ranking Use the “Job Descriptions” to select the WISE SSEP placements that most interest you. Your response will help us match you with an available position. NOTE: (2) indicates 2 available positions. All positions are subject to change as they are dependent upon the funding and supervision available. AVALON PENINSULA 1. Research Assistant: —Please choose an option—Very interestedSomewhat interestedNot interested 2. Design Assistant: —Please choose an option—Very interestedSomewhat interestedNot interested 3. Clean Energy-Subsurface Storage of Carbon Dioxide & Hydrogen Assistant (2): —Please choose an option—Very interestedSomewhat interestedNot interested 4. Science Summer Camp Counselor (2): —Please choose an option—Very interestedSomewhat interestedNot interested 5. Seabird Research Assistant (2): —Please choose an option—Very interestedSomewhat interestedNot interested 6. Research Assistant (2): —Please choose an option—Very interestedSomewhat interestedNot interested 7. Research Assistant: —Please choose an option—Very interestedSomewhat interestedNot interested 8. Green Chemistry Group Research Assistant (2): —Please choose an option—Very interestedSomewhat interestedNot interested 9. Research Assistant (2): —Please choose an option—Very interestedSomewhat interestedNot interested 10. Research Assistant- Materials Science & Engineering: —Please choose an option—Very interestedSomewhat interestedNot interested 11. Environmental Research Assistant: —Please choose an option—Very interestedSomewhat interestedNot interested 12. Computational Biochemistry Research Assistant (2): —Please choose an option—Very interestedSomewhat interestedNot interested 13. Plastics & Justice Laboratory Assistant (2): —Please choose an option—Very interestedSomewhat interestedNot interested 14. Ecology Research Assistant: —Please choose an option—Very interestedSomewhat interestedNot interested 15. Research Assistant- Scientific Computing with Python: —Please choose an option—Very interestedSomewhat interestedNot interested 16. Medicinal Chemistry of Drug Protein Binding Assistant: —Please choose an option—Very interestedSomewhat interestedNot interested 17. Research Assistant in Drug Education: —Please choose an option—Very interestedSomewhat interestedNot interested 18. Research Assistant: —Please choose an option—Very interestedSomewhat interestedNot interested 19. Remote Research Assistant: —Please choose an option—Very interestedSomewhat interestedNot interested 20. Student Research Assistant: —Please choose an option—Very interestedSomewhat interestedNot interested 21. Research Assistant: —Please choose an option—Very interestedSomewhat interestedNot interested 22. WISE Website Content Developer(2): —Please choose an option—Very interestedSomewhat interestedNot interested 23. Science Interpreter (2): —Please choose an option—Very interestedSomewhat interestedNot interested 24. Science Educator & Aquarist (2): —Please choose an option—Very interestedSomewhat interestedNot interested 25. Nursery Research Assistant: —Please choose an option—Very interestedSomewhat interestedNot interested 26. Education Intern- Camp Assistant: —Please choose an option—Very interestedSomewhat interestedNot interested 27. Education Intern- Program Support: —Please choose an option—Very interestedSomewhat interestedNot interested 28. Junior Applied Research Assistant (2): —Please choose an option—Very interestedSomewhat interestedNot interested 29. Laboratory Assistant: —Please choose an option—Very interestedSomewhat interestedNot interested 30. Environmental Technician: —Please choose an option—Very interestedSomewhat interestedNot interested WESTERN NEWFOUNDLAND 31. Physics Outreach Student Coordinator: —Please choose an option—Very interestedSomewhat interestedNot interested Job Placement Ranking The Selection Committee will try to place you with the Job that interests you the most based on your Job Preferences top 3 choices. Please rank your choices by listing the Job number and title below: (For example: “15. Research Assistant”) First Choice: Second Choice: Third Choice: SECTION 5: ADDITIONAL REQUIREMENTS Grades A copy of your most recent grades must be included. For applications submitted online, instructions will be included in the acknowledgement message that is sent to the applicant after clicking the “Submit” button. For email or postal mail, a copy must be attached to the email message or included in the mailed envelope. Teacher References Two teacher references are required. Please indicate who will be providing references for you. Name of Teacher Reference #1: Name of Teacher Reference #2: Residence During the SSEP employment period, do you plan to live with somewhere other than with your parent or guardian? YesNo