Exit Access Application Form 2019 Please do not leave fields blank. Answer N/A Question Title * 1. Contact Information Name: * Address 1: * Address 2: * City: Province/Country: * Postal Code: * Primary Email Address: * Alt Email Address: * Cell Phone #: * Alt Phone #: Question Title * 2. What post-secondary institution do you attend? SFU BCIT UBC Douglas College None Currently Other If other, please specify Question Title * 3. Educational Information Program of Study Specialization (if known) GPA Question Title * 4. When will you be graduating from your program of study? Month Year Date of Graduation N/A January February March April May June July August September October November December Date of Graduation Month menu N/A 2018 2019 2020 2021 Not Sure Date of Graduation Year menu Question Title * 5. Why are you interested in the Access Program? Question Title * 6. Please describe some of your interests, hobbies, extracurricular activities, and/or volunteer experiences. Question Title * 7. There will be a student led, collaborative component to the program. Please indicate the types of "problem solving" you might be interested in: 1 2 3 Social Issues: I want to have input on helping to solve larger social issues or I am interested in giving back to the community, 1 2 3 Environmental Issues : This is top of mind for me and I would like to contribute to a solution in some way with my peers. 1 2 3 Case Competition: I would love to particpate in helping to create a "case competition" or participate in a case competition where my peers and I are asked to present a solution to a real business problem. Question Title * 8. How did you hear about this program? Word of Mouth Student (Set) Rep Campus Club Event School Faculty Web Other (please specify) Question Title * 9. Please review the following commitments of our program, which will be required of you if you are accepted.i. Attendance at both orientation and graduation is mandatory. Orientation will be early November. Graduation date to be announced.ii. Ability to attend, in person, the minimum required number of events, workshops, and mentor meetings is a must.You must attend a minimum of 3 mentor meetings, 2 peer planned workshops and 2 BBOT events to complete the program. If you choose to participate on a committee you must attend at least 90% of the meetings and finish the program in good standing which will be judged by your committee chair and fellow committee members. iii. Missed mandatory requirements will mean in-completion of the program. Yes, I understand and agree. Next