zilongwang/ReadingBank huggingface dataset:
Postal Code: Home Country: E-mail: Telephone: Cell Phone: K. Academic Major, Institution: Major: Institution: Country: L. Work Experience, including previous positions and titles Name of your Institution/ Organization Title (Designation) Job Responsibilities From mm/dd/yyyy To mm/dd/yyyy M. Education, Academic and Professional Training: Please list all earned degrees and any and all current teacher qualifications you have such as certificates, licensures beginning with the most recent. Name of Degree(s)/Dip(s) When you earned mm/dd/yyyy When you expect to earn mm/dd/yyyy Additional Professional Training Name(s)/Types of Training Where or from whom did you get the training(s)? When did you get the training?
Other sources of funding for this activity if not 100% of full cost requested as part of this application Funding Source: Confirmed Yes / No 2019/2020 Amount 2020/2021 Amount 2021/2022 Amount Eligible Reserves- that will be used to fund the activity Business income Donations Fundraising Business Sponsorship Grant funding secured (please itemise) Funding being applied for (please itemise)
Signature: _____________________________________________________________________________________________________ Date:
Mr DAY ONE 22nd May 2017 08.00-08.15 Registration and Welcome 08.15-08.30 Overview Da Vinci Si and Xi Systems Nathan Bennett Lecture Theatre 08.30-09.15 Docking and Port Placement Paul Renforth Theatre Two 09.15-10.30 LIVE LINKS Theatres – Freeman Hospital Chair: Tony Chalhoub Phillipe Van Trappen Mark Roberts Lecture Theatre
10.30-10.45 Refreshments 10.45-11:30 Step by Step Robotic Radical Hysterectomy Phillipe Van Trappen Lecture Theatre 11.30-12.15 Robotics in Gynaecological Oncology: The Royal Marsden Experience Marielle Nobbenhuis Lecture Theatre 12.15-1.00 Lunch 1.00-2.30 LIVE LINKS Theatres – Freeman Hospital Tony Chalhoub Mr Mark Roberts Lecture Theatre 2.30-3.15 Robotics in Gynaecological Oncology: The Royal Surrey Experience Simon Butler-Manuel Lecture Theatre 3.15-3.30 Refreshments 3.30-3.45 History of Robotic Surgery Tony Chalhoub Lecture Theatre 3.45-4.00 What Can Go Wrong Paul Renforth Lecture Theatre 4.00-4.30 Discussions Q & A All Faculty Lecture Theatre 7.30 for 8pm Dinner Café 21 , Trinity Gardens Quayside 09.15-10.45 GROUP ONE Da Vinci - Dissection-Hysterectomy 10.45-12.15 GROUP TWO Da Vinci – Dissection Sidewall and Suturing 12.45- 2.15 GROUP THREE Da Vinci – Dissection Hysterectomy 2.15- 3.45 GROUP FOUR Da Vinci – Dissection Sidewall and Suturing DAY TWO – 23rd MAY 2017 08.45-9.00 Coffee and Change 09.00-09.25 Anaesthetic Challenges in Robotic Surgery Mathew Garner Lecture Theatre 09.25-09.40 Cost Implications & Business case Russ Watkins Lecture Theatre
Gambling and Racing Control Act 1999, s 53D GAMING MACHINE ACT 2004, s 38M(1)(a) APPLICATION – AMEND IN-PRINCIPLE APPROVAL – INCREASE OR DECREASE THE NUMBER OF RESERVED GAMING MACHINES SECTION 1 - Details of Applicant. An applicant may be: The holder of an in-principle approval provided under the Gaming Machine Act 2004. Name of Applicant (enter text) Address of Registered Office (enter text) Physical Address (enter text) Postal Address (enter text) Contact Person (enter text) Telephone (enter text) Facsimile text) Email Address (enter text) SECTION 2A - Details of INCREASE to the number of Gaming Machines reserved under the in-principle approval. Please note that a Social Impact Assessment must be provided for this type of application. Current Number of reserved Gaming Machines (enter text) Increase to number of reserved Gaming Machines (enter text) Total number of reserved Gaming Machines after proposed amendment (enter text) SECTION 2B - Details of DECREASE to the number of Gaming Machines reserved under the in-principle approval. Current Number of reserved Gaming Machines (enter text) Decrease to number of reserved Gaming Machines (enter text) Total number of reserved Gaming Machines after proposed amendment (enter text)
Making Effective Decisions Think through the implications of own decisions before confirming how to approach a problem or issue E Investigate and respond to gaps, errors and irregularities in information E PEOPLE CLUSTER – ENGAGING PEOPLE Leading and Communicating clearly in plain simple language and check work for spelling and grammar, learning from previous inaccuracies. E Act in a fair and respectful way in dealing with others E Collaborating and Partnering Proactively contribute to the work of the team E Proactively seek information, resources and support from others outside own immediate team in order to help achieve results. E Building Capability for All Identify your own skills, knowledge and behaviour gaps to inform own development plan and discuss these with the line manager. D PERFORMANCE CLUSTER – DELIVERING RESULTS Achieving Commercial Outcomes Be aware of and comply with Department procurement processes and know when to access commercial expertise D Learn about customers and supplier needs D Delivering Value for Money Maintain recognised financial procedures and practices E Handle numbers confidently; collate information ensuring accuracy of financial and performance data. E Managing a Quality Service Encourage customers to access relevant information or support that will help them understand and use services more effectively. D Act to prevent problems, reporting issues where necessary E Delivering at Pace Work in an organised manner own knowledge and expertise to deliver on time and to standard. E Work with energy and pace to get the job done E
8 Required Documentation Declaration of conformity issued by Manufacturer Technical/Operational Documents of the RTTE including user/installation manual Test reports from accredited laboratory Circuit diagram, PCB layout, parts list and other relevant design information Photographs (external/internal) Label Test report issued by Accredited Test Labs recognized by ZICTA Proof of payment of Type Approval Fees to ZICTA B. TECHNICAL DETAILS OF THE EQUIPMENT Information Provided 9 Equipment Category (Tick Appropriate) ] GSM ] DECT ] UMTS/3G/4G ] TETRA ] Amateur Radio ] Private Mobile Radio ] Radar ] Maritime Radio ] Radar ] RLAN ) ] Wimax ] FWA ] Microwave ] Sound ] TV ) ] WiFi ] Bluetooth ] RFID ] Amarteur Satelite Radio ] Radio Navigation ) ] Satelite TV ] VSAT ] Analog PSTN ] xDSL ] Voice Equipment ) ] Leased Line Equipment ] Switched Data ] Other (Specify) ) Intended Use Private: ] Commercial: ] Retail: ] Other: (specify) 10 Equipment Details Brand Name: Type Name: Model Number: Country of Origin: Frequency Range Bandwidth: Transmission Capacity: No. of Channels: Output Power (mW): Channel Spacing: Frequency Stability: Modulation Type(e.g. AM, FM, OFDM etc):
SECTION 2: EDUCATION AND TRAINING List details of relevant qualification in REVERSE starting with most recent first (i.e. professional qualification, degree, A levels, GCSEs or equivalent, and any other further qualifications). Please clearly demonstrate how you meet the advertised criteria. Only qualifications listed will be taken into account. At offer stage, candidates will be required to provide copies of certificates. You may include an additional sheet for this section, if more space is required. FROM Month Year TO Month Year TYPES OF EDUCATIONAL ESTABLISHMENT TYPE & LEVEL OF EXAMINATIONS/SUBJECT TAKEN GRADE Please give details of any training/relevant courses attended, with dates. COURSE DATES
Section 4 – Diversity Monitoring Applications are welcome from all suitable individuals irrespective of, for example, age, race, gender or disability. You are asked to complete this questionnaire to help us to monitor the effectiveness of this policy. This information may be reproduced in summary form only in Government or OCPA publications (including websites) or in response to parliamentary questions/enquiries and other public enquiries. Individuals will not be identified or be able to be identified in any such responses. This questionnaire will be kept separate from the application form, will not be seen by the sift and interview The Data Protection Act requires that individuals must be informed, and their consent given, for this information to be made publicly available. If you are content, please complete as much of the following that you are comfortable with: I consent to the information I have entered below being used as described. Yes No Ethnicity Which groups do you most identify with? Please tick ONE box in Section A and ONE box in Section B Section A White Chinese Any Chinese background (specify if you wish) Bangladeshi Indian Pakistani Any other Asian background (specify if you wish) Mixed Ethnic Background Asian and White Black African and White Black Caribbean and White Any Mixed Ethnic background (specify if you wish) Black African Caribbean Any Black background (specify if you wish) Any other ethnic background Any other ethnic background (specify if you wish) Section B Please select one of
Darwin Darwin Corporate Park Ground Floor, Building 3 631 Stuart Highway Berrimah GPO Box 9800 Darwin NT 0801 t (08) 8982 1700 f (08) 8982 1725 Toll free 1800 193 111 territory.businesscentre@nt.gov.au Katherine Shop 1, Randazzo Building 18 Katherine Terrace Katherine PO Box 9800 Katherine NT 0851 t (08) 8973 8180 f (08) 8973 8188 e Tennant Creek Shop 2, Barkley Cnr Davidson and Paterson Street Tennant Creek PO Box 9800 Tennant Creek NT 0861 t (08) 8962 4411 f (08) 8982 1725 e Springs Ground Floor, The Green Well Building 50 Bath Street Springs PO Box 9800 Springs NT 0871 t (08) 8951 8524 f (08) 8951 8533 e
Timeframe: Other Cost: $ Brief Description of Pre Training: Timeframe: Costs Subtotal: $ Check Deliverables Cost of Each Deliverable Brief Description of Pre Training Time Needs Assessment Curriculum Development Sample Included in module Other Subtotal Required: $ Training Deliverables Cost of Each Deliverable Brief Description of Training Month of Delivery Subtotal Required: Training Deliverables Cost of Each Deliverable Brief Description of Training Month of Delivery Subtotal Required: Training Deliverables Cost of Each Deliverable Brief Description of Training Month of Delivery . Subtotal Required: Post Training Deliverables Cost of Each Deliverable Description of Training of Delivery Program Evaluation Other Subtotal Required: $ Total Cost of Training Program to Business: Training Program End Date:
Dates The date(s) of the education program is: Relevance Briefly describe how this opportunity will meet at least one of the purposes of the Barbara Burt Innovative Leader Fund and how that purpose will impact the organization you serve. Capacity Building Is the organization currently involved in capacity building work? If so, how does this request support or relate to that work?
If you like more information about this process or any help completing this form please phone 0300 244 7000 or email us on Advice - If you have questions about this application contact one of the following: your local council; Shelter Scotland; your local Citizen’s Advice Bureau; a solicitor (you may be able to get aid depending on your income). the Scottish Association of Landlords (a membership organisation) GUIDANCE FOR LANDLORDS Question 1(a) This is the address of the property you currently live. We may phone you or send an email so please give us your current telephone number and email address. Question 3 Please give us details of all the improvements you have made to the Let Property since the start of the tenancy, or since the rent has changed during the current tenancy (if applicable). Question 1(b) If an agent (or another person) acts on your behalf, please give us all their contact details, including their address. This can be someone who acts on your behalf to deal with your personal affairs. You must have agreement with this person that they can carry out this role for you. Question 4 This is the additional amount of rent that you would like to add to the current rent for your Let Property because of the improvements you have made. Question 2(a) This is the address of the Let Property where you have made improvements. Question 5 Please send all the necessary documents with your application, ticking the appropriate box(es) to show that you have done this. Question 2(b) To decide on an additional amount of rent for improvements made to the Let Property, we may need to inspect it. Please give us all the necessary contact details for the Tenant. Question 6 You/ your agent must sign the form. Failure to do so will make the application invalid. You do not need to sign the form if you are filling it in online. Question 1 – Landlord’s Details Name Address Postcode Telephone Number Email Address Your Agent’s contact details (if any)
Date : CERTIFICATE OF COMPLIANCE This certificate of compliance validates the following TEST REPORT NUMBER ‘Assessment Reports’ are not acceptable CERTIFICATE NUMBER DATE OF ISSUE DATE OF ISSUE DATE OF EXPIRY DATE OF EXPIRY Manufacturer details (To be completed by customer) NAME OF FACTORY/ MANUFACTURER NAME OF THE BRAND FACTORY ADDRESS / REGION (STREET / TOWN / CITY / COUNTRY ) MODEL / NO WEBSITE LOGO ON THE PRODUCT TEL
Date Time Location Counselors Wed. October 10th 2pm - 5pm PB 19 1. 2. 3. Mon. October 15th 11am – 2pm PB 19 1. 2. 3. Thu. October 25th 1pm - 4pm PB 19 1. 2. 3. Tue. October 30th 3pm – 6pm PB 19 1. 2. 3. Tue. November 6th 1pm – 4pm PB 19 1. 2. 3. Wed. November 14th 2pm – 5pm PB 19 1. Celia 2. 3. Mon. November 19th 11am -3 pm PB 19 1. 2. 3. Thu. November 22nd 1pm - 5pm PB 19 1. 2. 3. Tue. November 27th 1pm - 6pm PB 19 1. 2. 3. 4. Wed. November 28th 2pm – 6pm PB 19 1. 2. 3. 4. Thu. November 29th 2pm – 6pm PB 19 1. 2. 3. 4. Fri. November 30th 9am – 3pm PB 19 1. 2. 3. 4.
Field No. Planned for 2019 Crops Inputs 2018 Inputs 2017 Crops Inputs 2016 Crops Inputs Field #: Acres: ______ Name of Manager 2018: ______________________ 2018 Manager’s Signature/Date: Name of Manager 2017: _______________________ 2017 Manager’s Signature/Date: Name of Manager 2016: _______________________ 2016 Manager’s Signature/Date: Field #: Acres: ______ Name of Manager 2018: ______________________ 2018 Manager’s Signature/Date: Name of Manager 2017: _______________________ 2017 Manager’s Signature/Date: Name of Manager 2016: _______________________ 2016 Manager’s Signature/Date: Field #: Acres: ______ Name of Manager 2018: ______________________ 2018 Manager’s Signature/Date: Name of Manager 2017: _______________________ 2017 Manager’s Signature/Date: Name of Manager 2016: _______________________ 2016 Manager’s Signature/Date:
Additional Information -Skills, Knowledge, Experience Please clearly demonstrate your experience in the ‘details’ boxes below, where you have ticked ‘yes’ and explain why you think this is relevant to the requirements of the post. Please demonstrate how you meet the requirements using examples. Reference should also be made to any relevant voluntary positions and leisure time interests. Continue on a separate sheet if necessary. Essential (E) – The minimum acceptable levels Desirable (D) – Attributes of the ideal candidate Skills, Knowledge & Experience Required: Essential/ desirable criteria Please indicate if you meet the criteria A dynamic self starter who thrives on change, learning and innovation E YES or NO (please delete as appropriate) Details: Ability to manage significant budgets and projects within timescales and to meet projected costs and quality standards E YES or NO (please delete as appropriate) Details: Excellent working knowledge of IT systems in managing contracts and performance ; including Microsoft Word, Project, Excel and other databases E YES or NO (please delete as appropriate) Details: Project management skills E YES or NO (please delete as appropriate) Details: Significant experience and understanding of delivering property based and community based project management services, preferably in the social housing sector E YES or NO (please delete as appropriate) Details: record of delivering effective procurement contract management, balancing quality and price, and working knowledge of procurement legislation, directives and requirements for compliance E YES or NO (please delete as appropriate)
ZIP in the LHD’s jurisdiction (please list all, separating each with a comma) What RUCA codes does your agency’s jurisdiction cover? Current number of staff: full-time equivalents (FTEs) CONTRACT INFORMATION Selected LHDs will enter into a contract with NACCHO to complete the deliverable(s) outlined in the RFP. To expedite the contracting process for selected sites, agreement with NACCHO standard contract terms and conditions is a requirement for application. No modifications will be made. The information below will help to begin the contracting process immediately upon selection. The LHD (or entity that will be contracting with NACCHO, e.g., city government), including any relevant financial or legal offices, has read NACCHO’s standard contract language and would be able to enter into a contract without making modifications to the terms and conditions. Yes No The LHD (or contracting entity) will be able to sign and return a contract to NACCHO within 20 calendar days of receipt. Yes No If you selected ‘No’ to either of the above, please explain. TEAM INFORMATION Partner 1: LHD Primary contact name and information Name: Email: Title: Partner 2 Information Name:
BLOCK ONE SCORE _____ of 120 BLOCK TWO CATEGORY Ten Points Eight Points Six Points Four Points Population Decrease The applying municipality has suffered a population decrease of greater than seven present between the 2000 and 2010 census The applying municipality has suffered a population decrease of greater than five present between the 2000 and 2010 census The applying municipality has suffered a population decrease of greater than three present between the 2000 and 2010 census The applying municipality saw a population increase between the 2000 and 2010 census Housing Inventory The municipality has a housing inventory in excess of 20% of that which is needed The municipality has a housing inventory in excess of 15% of that which is needed The municipality has a housing inventory in excess of 10% of that is needed The municipality has a housing inventory that does not adequately provide for its current population Green Demolition The application involves either deconstruction or salvage for more than half of the properties The application involves either deconstruction of salvage for more than twenty-five percent of the properties The application involves either deconstruction of salvage for more than ten percent of the properties The application involves neither deconstruction or salvage of the properties Neighborhood Composition Over sixty percent of properties in the target neighborhood are believed to be owner occupied Over fifty percent of properties in the target neighborhood are believed to be owner occupied Over percent of properties in the neighborhood are believed to be owner occupied Over thirty percent of the properties in the neighborhood are believed to be occupied BLOCK TWO SCORE _____ of 40 BLOCK THREE CATEGORY Ten Points Five Points Two Points Zero Points Innovative Demolition Concepts The applicant has contracted, negotiated or created a concept to save funds on the cost of every demolition The applicant has contracted, negotiated or created a concept to save funds on the cost of a portion of the demolitions The applicant has contracted, negotiated or created a concept to save funds on the cost of a service or product secondary to demolition
Benjamin B. Ferencz Fellowships in Human Rights and Law Application Please submit a completed application, your résumé, and a 200 – 250-word letter of intent explaining your interest in the fellowship as a single pdf or word document to by July 15, 2017. Name Address City Zip Phone Email address Please carefully review the position descriptions and qualification requirements to completing an application. Indicate your position of interest (please number them in order of preference, with #1 your preferred position): ☐ International Criminal Court ☐ CEDAW (Convention on the Elimination of Discrimination Against Women) ☐ Genocide of the Herero ☐ Climate Change and Violence ☐ I am interested in MJF (Minnesota Justice Foundation) recognition. ☐ I am interested in receiving academic credit and receiving a stipend. Educational background Undergraduate Institution Degree Major Graduation year GPA Special training (e.g. courses in genocide studies, human rights, or related fields; published papers; leadership experiences; etc.) Graduate (if applicable) Institution Degree Major Graduation year GPA Special training (e.g. courses in genocide studies, human rights, or related fields; published papers; leadership experiences; etc.) Law school Institution
ETUDES ANTERIEURES A DE MASTER 2 Previous studies Nature des diplômes (Type of diploma) Discipline Année d’obtention (Year of completion) Etablissement (Institution) Mention (Grade or Honor) Moyenne (Average Mark if any) Master 1 (M1), Maîtrise (M) ou diplôme équivalent (DE) Licence ou diplôme équivalent (Bachelor) D.E.U.G ou diplôme équivalent (Other diploma) Baccalauréat (Secondary level diploma): Série (Discipline) : Mention (Honors): Date : Lieu (Location): Autres formations (Other type of Education and Training:)
TASMANIA FISHERIES (MARINE RULES 2017 STATUTORY RULES 2017, No. CONTENTS PART I -PRELIMINARY Short title Commencement 3. Interpretation 4. Application of rules 5. Duration of rules 6. Classes of fishing licence PART 2 - GENERAL MANAGEMENT OF FISHERY Closed and open seasons Closure of fishery to certain fishing activities PART 3 -LICENCES Division 1 - General Licences are non-transferable Restriction on granting subsequent marine plant fishing licences Division 2 -Fishing licence (marine plant) Authority of fishing licence (marine plant) Endorsement of fishing licence (marine plant)
Possessing cast native marine plants for commercial purposes A person must not possess, for commercial purposes, more than 1OOkg of cast native marine plants cumulatively in a licensing year. Penalty: Grade 2 penalty. Subrule (1) does not apply to - the holder of a fish processing licence; or a person who is acting under the authority of a marine plant fishing licence; or a person who purchased or received the cast native marine plants from a person referred to in paragraph (a) or (b). Removal of cast marine plants constituting public nuisance The Secretary, by instrument in writing, may authorise a person to remove cast marine plants from an area specified in that instrument, if the Secretary reasonably considers that the marine plants in that area constitute a public nuisance. The Secretary may make an authorisation under subrule (1) subject to such conditions as the Secretary thinks fit. The holder of an authorisation subrule (1) must comply with the conditions of that authorisation.
SCHEDULE 1-INFRINGEMENT NOTICES AND PENALTIES Rule 40 Column 1 Item Column 2 Rule Column 3 Penalty (penalty units) 1. Rule 7(2) 2 2. Rule 8(2) 2 3. Rule 12(2) 2 4. Rule 19(2) 2 5. Rule 20(2) 2 6. Rule 21(2) 2 7. Rule 22 2 8. Rule 23(1) 2 9. Rule 24(3) 2 10. Rule 25 2 11. Rule 26 2 12. Rule 28(1) 2 13. Rule 28(2) 2 14. Rule 29(2) 2 15. Rule 31 2
Printed and numbered m accordance with the Rules Publication Act 1953. Notified in the Gazette on 20 . These rules are administered in the Department of Primary Industries, Parks, Water and Environment. EXPLANATORY NOTE (This note is not part of the rules) These rules provide for the management of the marine plant fishery.
2. 4C’s of Rural and Remote NSW Budget: $15000 + Must: Provide support for primary, secondary or central schools in NSW Address each area of the 4Cs - creativity, communication, collaboration and critical thinking Involve more than one school or communities of schools and a team of teachers working together Be focused on the teaching and learning environment. purchasing of subject relevant equipment such as classroom musical instruments and re-writing classroom programs encompassing the 4Cs. establishing community and school links to collaborate across regions. implementation of an instrumental ensemble (such as a band, percussion, recorder or ukulele group), choir or drama (such as theatresports) program to accompany classroom units of work by existing internal staff members only (not external providers). development and exhibition of works or performances to accompany classwork or curriculum. financial assistance for regular interactions with current productions and public exhibitions in the Creative Arts that support syllabus implementation. online development of curriculum materials or professional learning activities. 3. First Nations Arts Budget: $3000-$10000 Must: Involve action research and professional learning leading to the development of teaching and learning activities. Involve one or more teachers working together. explore the cultural identity of Aboriginal people, students or communities in regional NSW through the creation of short videos or interviews through a student-driven media team. Create a support document linking to specific outcomes within the creative arts curriculum. creation of resources and professional learning for effective implementation of Aboriginal and Torres Strait Islander content into classroom programs. development of subject relevant units of work connecting Aboriginal communities to school communities through the Creative Arts. link and engage Aboriginal artists, arts and culture in various parts of NSW in a series of teaching and learning programs.
INSTITUTIONAL DEVELOPMENT: PAYMENT SUBMISSION FORM FOR APPLICATION SUBMISSIONS School(s) # School(s) (Please list all schools applicable to payment) City State Application Type(s) *Please refer to attached list for application types Payment Amount(s) (Enter payment amount for each application type) Total Payment Amount Check Number Name of contact person(s) Title(s) contact phone number(s) contact email(s) Please submit this payment form with each check payment. Submit To: Operations Department Accrediting Commission of Career Schools and Colleges 2101 Wilson Boulevard, 302 Arlington, VA 22201
*Application Type(s) Application of Hours for Clock Hour Programs Application for Continuing Education and Avocational Courses Application for Approval of a Baccalaureate Degree Application for Approval of an Academic Associates Degree Application for Approval of a Masters Degree Application for Approval of an Occupational Associates Degree Application for a Branch Part I Application for a Branch Part II Application for a Branch Realignment, Part I Application for a Branch Realignment, Part II Application for a Change of Location Part I Application for a Change of Location Part I Application for a Change of Name Part II Application for a Change of Ownership Part I Application for a Change of Ownership Part II Application for Clock to Credit Hour Conversion Application for a Distance Education Facility Application for Initial Distance Education Application for Expansion of Distance Education Approval Application for a Change of Mission Application for English as a Second Language Courses Application for a New Non-Degree Program Application for a Satellite Location Application for a Substantive Program Modification Application for a Substantive Program Modification Addition of Concentration Change of Ownership Report Consortium Partnership Report Distance Education Consortium Partnership Agreement Facility Expansion Report Program Modification Report Modification Application for a Baccalaureate Degree – Affiliated Application for an Associate Degree – Affiliated Application for a New Non-Degree Program – Affiliated Application for a Substantive Program Modification – Affiliated Application for a Clock to Credit Hour Conversation – Affiliated Program Modification – Non Substantive Modification - Affiliated
Application for a Duplicate Academic Transcript/ Diploma Supplement Details of Award Full Name at the time of the Award Student number if known Date of Birth Award Conferred Classification Year of Award Award Title Current Address Email address Telephone number Please enclose a form of identification with your application. If your name is the same as when you graduated you may use a photocopy of either of the following, Passport, Driver’s Licence or Birth Certificate. If your name has changed since you graduated your application must be accompanied by a legally valid certification of your former name e.g. Marriage Certificate or Deed Poll Certificate Notes: Replacements will bear the name of the graduate as they were known at the time of graduation i.e. names cannot be changed except under exceptional circumstances. Replacements will carry the following statement ‘This is a certified duplicate Academic Transcript/Diploma Supplement, reissued on 00/00/00. Duplicate Academic Transcripts/Diploma Supplements will only be sent directly to the applicant. Applicant’s signature
Identification Provide three certified true copies of identification which includes at least one Category A. Category A: Category B: Previous names: (if applicable) Position held in company: Contact phone No.: Contact email: Current residential street address: No. and street name Suburb / town State Postcode Previous residential street address (within the last 5 years) National police certificate attached Original Certified copy Not provided - last provided: Previous business experience*: Convictions
Applicant’s details Your full name Full postal address including postcode Contact telephone number Alternative contact telephone number Email address Are you applying for your own certificate? – Please click yes/no using the drop down options. Certificate details Full name of party one at the time of marriage including any middle names and surname Full name of party two at the time of marriage including any middle names and surname Date of marriage (dd/mm/yyyy) Place of marriage (please provide address if known) How you like to receive the certificate? Collect – Please click yes/no using the drop down options. (Chester Register Office only). Posted – Please click yes/no using the drop down options. (Postage fees apply £2.50 in UK or £3 if abroad). Please provide the full address including postcode for posting the certificate(s) if different from the address given above in ‘applicant’s details’. How many certificates do you require? – Please click the number using the drop down options. (Certificate cost is £10 each). For official use only Application received date: Time: Officer’s initials: Payment received date: Time: Fee collected: Debit/ credit card: Officer’s initials: Register number: Entry number: Certificate number: Details of non-contact Attempt one date: Time: Officer’s initials: Attempt two date: Time: Officer’s initials: Details of how the customer received their certificate Date collected from Chester Register Office: Date posted:
ANNEXURE C: APPLICATION FORM UNIVERSITY OF ZULULAND POSTDOCTORAL RESEARCH FELLOWSHIP APPLICATION FORM RESEARCH AREA OR THEME AREA OR THEME POSSIBLE ACADEMIC DEPARTMENT OR RESEARCH ENTITY BIOGRAPHICAL INFORMATION AND CONTACT DETAILS Surname: names: Title: Gender: Citizenship: Date of Age: Email address: Postal address:
The Department of Attorney General and Justice complies with the Information Privacy Principles scheduled to the Information Act. Lodgement - Territory Business Centre Incomplete applications cannot be processed and will be returned. Complete applications, together with payment and all supporting documents can be lodged at the Territory Business Centre either in person, post, fax or email. Darwin Ground Floor, Development House. 76 The Esplanade Katherine Shop 1, Randazzo Building. 18 Katherine Terrace. Tennant Creek Shop 2, Barkly House Cnr Davidson and Patterson Street. Alice Springs Ground Floor, The Green Well Building. 50 Bath Street 1800 193 111 Email: territorybusinesscentre@nt.gov.au Postal: GPO Box 9800, Darwin, NT 0800 Fax: 08 8982 1725 Payment Details Payment Method Cash - Territory Business Centre Cheque - payable to RTM (Receiver to Territory Money) Credit Card Visa MasterCard Credit Card number Expiry Name on card I hereby authorise the Territory Business Centre to debit the above credit card the amount of: $ Signature of cardholder Date
To be submitted for a substantial increase or decrease (a cumulative modification of 25 percent or more from the original date of program recognition or the most recent accreditation review) in the clock hours or credit hours of an existing approved program (Section IV (E)(6)(a)(i), Rules of Process and Procedure, Standards of Accreditation). If the school is making substantive modifications to one program offered at more than one affiliated school, do not complete this application. Please complete the Application for a Substantive Program Modification – Affiliated Schools. School # School Name Type City State Degree Granting Main: Yes: Branch: No: Contact Person Phone Email 1. Type of Substantive Program Modification (Please Check All That Apply): Change in Clock Hours Change in Credit Hours Change in Type of Credit Hours Substantive Change in the Type of Credential Awarded (e.g., occupational to academic associate degree) 2. Program Information PRIOR to the Modification: Program Title (e.g. Business Administration) Instructional Clock Hours Total Clock Hours & Outside Prep Hours Total Credit Hours Type of Credit Full Credential & Abbreviation Externship Information (Externship hours as listed on the Outline of a Degree Program; may include multiple courses) Semester: Total Externship Clock Hours: Quarter: Total Externship Credit Hours: 3. Program Information AFTER the Modification: Program Title (e.g. Business Administration) Instructional Clock Hours Total Clock Hours & Outside Prep Hours Total Credit Hours Type of Credit Hours Full Credential & Abbreviation Externship Information (Externship as listed on the Outline of a Degree Program; may include multiple courses) Semester: Total Externship Clock Hours: Quarter: Total Externship Credit Hours: I certify that the information herein and attached hereto is correct. Name Signature Title Date
B. I consider that I have a disability YES NO If YES, please state details of your disability. …………………………………………………………………………………………… …………………………………………………………………………………………… …………………………………………………………………………………………… C. AGE. Please tick one box to indicate relevant category 16 – 20 21 – 25 26 – 30 31 – 35 36 – 40 41 – 45 46 – 50 51 – 55 56 – 60 61 + D. Where did you find out about this post? Please tick box or state as indicated. Advert in Times Educational Supplement (TES) Borough of website Other Please specify………………………………………………………….
Please note that a decision may be made on this application on the information you have provided and any other supporting documents. You may not have a further opportunity to provide documents or evidence. What is the value of the debt you are seeking waiver of? $ Consent and acknowledgment I understand that in investigating my application, the Department of Finance may make relevant enquiries and share information with other Australian Government agencies and those Australian Government agencies may provide information to the Department of Finance. I understand that there is no automatic entitlement to a waiver of a debt. Signature Date Authority for Representative Complete the following details if you would like another person or organisation to act on your behalf when dealing with the Department of
Details of all previous employment Record of all teaching experience, excluding present post, in chronological order. (Students seeking first appointment should enter details of teaching practice). Please ensure the ‘Reason for Leaving’ column is completed. Continue on a separate sheet if necessary Name and address of employer – Employing Authority inc area if appropriate School (name and type) Job title, grade, salary (approximate if known) and brief job details (full/part-time) No. on Roll Ages taught employed Reason for Leaving From To Please account for any employment gaps: Were you paid on the Pay Scale (Threshold) Yes No If yes which point and date applicable from? Date from State age group for which mainly trained? What is your principal teaching subject? For what other subjects are you appropriately trained or qualified?
Relevant skills, qualifications & training Please give details of qualifications obtained and training received which are relevant to the job for which you are applying. Educational, professional and vocational qualifications and training (in chronological order). Please state where professional qualifications were obtained by examination or otherwise e.g College/University. Dates studied for Date obtained Grade/Level achieved. Qualifications obtained and subjects passed. (If degree state whether with honours and give class and subjects) From To Qualifications other than a degree entitling you to the rank of a graduate for salary purposes or if specially recognised by the Department for Children, Schools and Families (DCSF). Please give particulars with dates:- Educational Courses attended in the last 4 years: Title Date Duration of course
Application For:- Headteachers/ Deputy Headteachers/ Teaching Appointments School/Service Area: Bridgeview, Whitehouse, Sullivan Centre Job Position Number: Closing date: Contact Number: PART 3 Application for Employment CONFIDENTIAL CRIMINAL RECORD INFORMATION – ENHANCED CLEARANCE IMPORTANT – Please read carefully Please read the Disclosure of Criminal Record Information Sheet attached to the person specification before answering the following questions. Do you have any criminal record information that the Council requires you to disclose? Yes No If “Yes”, please give details in the appropriate sections(s) UNSPENT CONVICTIONS Nature of Offence Date of Offence Date of Sentence/ Order Location of Court Full name at time of Offence/ Sentence/Order* PROSECUTIONS PENDING – You only need to complete this section if the job for which you are applying requires a Standard or Enhanced Disclosure Nature of Alleged Offence Date of Alleged Offence Court Date (if known) Location of Court Full name at time of Alleged Offence*
Last name, First name: Student registration number: Email: Dates of stay abroad: Study program: Partner university: Examination regulations: PSTO 2016 Country: Module title and Sub-module numbers For example: Contemporary EU Society For example: 5 CP For example: A- For example: In-depth Society TD S 5 Wahlpflichtmodul 680127000 In-depth Society 680127100 For example: Module Examination 680127500 For example: 5 To be filled in by EUCS To be filled in by EUCS / a a
fits into your dissertation project. (max 100 words) Do you have, or are you applying for funding to support this exchange? Please list funding source, amount and whether you have applied or have been successful. Research students at UQ are enrolled through a for their program of study. Research study at UQ operates under four a year. It is preferred that students aim to start, where possible, within the first month of a research quarter. operates under a semester schedule with 3 semester/year. Students desiring to take classes must plan on participating in the exchange for a full semester. Students desiring to conduct research only need not adhere to the semester schedule. CURRENT STUDY DETAILS Research project title: Name of home institution: Home institution Advisor: Date of enrolment: Intended completion date: Applicants must be currently enrolled as a doctoral student and have completed a minimum of one year of full time study towards their doctoral program at the home institution before commencing studies at the host institution. UQ students must have successfully completed their confirmation milestone. HEALTH COVER (OSHC) I am an Emory student and will be studying for less than 12 weeks and my healthcare coverage is provided by Emory’s insurance policy. (You may skip to the next section) I am a UQ student studying at Emory and will be covered by UQ’s insurance policy for the duration of my studies. (You may skip to the next section) I am an Emory student studying in Australia for more than 12 weeks and will be on a student visa, so require Overseas Student Health Cover. (you must complete the section below) An international student who will be studying at UQ on a student visa must maintain Overseas Student Health Cover (OSHC) for the duration of the student visa in Australia. UQ can organise visa-length cover with its preferred provider on your behalf. I would like UQ to arrange: Single premium OSHC Dual family premium OSHC Multi-family OSHC I do not want UQ to arrange: I will arrange my own health cover for the duration of my student visa. I am covered by a government insurance scheme recognised by Australia. Single premium health cover is for yourself only; Dual family premium health cover is for yourself and one other dependent; Multi family premium health cover is for yourself and multiple dependents.
College of Education and Science | Teacher Education Application for Admission to a Professional Program You must have accumulated a minimum of 48 credits and have a CGPA of 2.50 or higher to apply for a professional program. Completion of this admission form is the first step in the process of applying for a professional program. Additional information is available in ED 201 Introduction to Teaching and Foundations of Education. A copy of this form must be submitted to the Education Office. Name Last First Middle Date Banner ID Male Female E-mail Phone (cell or land line) Address: Street City, State Zip Date of Birth Ethnicity (optional) Current CGPA Completion Date (semester/year) Indicate below the professional program for which you are applying: Public Classroom Teacher Lutheran Classroom Teacher Major/Licensure Area: Parent and Family Education Early Childhood Education (Birth – Grade 3) Elementary Education (Grades K – 6) Childhood Endorsement 5-8 Communication Arts/Literature Endorsement 5-8 Math Endorsement 5-8 Social Studies Endorsement Chemistry (Grades 9 – 12) Life Science (Grades 9 –12) Communication Arts/Literature (Grades 5 – 12) Mathematics (Grades 5 – 12) Social Studies (Grades 5 – 12) Visual Art (Grades K – 12) Music (Grades K – 12) Instrumental Music (Grades K – 12) Physical Education teaching (Grades K – 12) and Health teaching (Grades 5 – 12) English as a Second Language teaching (Grades K – 12) I understand that if I voluntarily drop out of the program for more than two semesters (not including summer school), or if the university discontinues my status in the program for academic or other reasons; and, I am not readmitted within four months after this action, upon readmission, I will be subject to the licensure regulations in force at the time of readmission. ____________________________________________________________________ ____________________________ Signature of Student Date
List of participating developers and lenders, if applicable I Bond Counsel Certification and Special Survey regarding average area purchase prices with certification, if applicable (Section 143(d) of the Internal Revenue Code) J Bond Counsel Certification and Special Survey regarding area median income with certification, if applicable (Section 143(f) of the Internal Revenue Code) K Resolution regarding existing units for lower incomes, if applicable (Cal. Health & Safety Code Sections 34312.4(d)(2) and 52020(d)(2)) L Evidence of Minimum Requirements (See Section 5266(a) of CDLAC Regulations) M Evidence of undue hardship/financial burden re: Minimum Requirements, if applicable (See Section 5266(b)&(c) of the CDLAC Regulations) M-1 Evidence of housing element compliance (See Section 5267 of the Regulations) N Certification regarding use of year allocation (Section 5268 of the CDLAC Regulations) O Evidence of undue hardship/financial burden re: Minimum Requirements, if applicable (See Section 5266(b)&(c) of the CDLAC Regulations) O-1 Evidence of past Program performance (See Section 5275 of the CDLAC Regulations) P Required Tracking Information EXHIBIT * [NOTE: Any subsequent mailings of additional application materials should be in duplicate.] PERFORMANCE DEPOSIT CERTIFICATION FORM FOR AN APPLICATION FOR AN ALLOCATION OF QUALIFIED PRIVATE ACTIVITY BONDS The California Debt Limit Allocation Committee (CDLAC) 915 Capitol Mall, Room 311 Sacramento, CA 95814 (916) 653-3255 CERTIFICATION OF THE (Applicant) REGARDING AN APPLICATION FOR QUALIFIED PRIVATE ACTIVITY BOND ALLOCATION In connection with the following Qualified Private Activity Bond Application: APPLICANT: AMOUNT OF ALLOCATION REQUESTED: $ PROJECT NAME/PROJECT TYPE: the undersigned officer of the (Applicant) hereby certifies as follows: I, (Name), am the (Title) of the (Applicant), and am duly authorized to make the deposit required below. The (Applicant) has collected and has placed on deposit in an account in a financial institution $ , dollars (write out dollar amount in words), which equals one half of
Instructions for completing an application for the grant of an aboriginal coastal licence As the submitted form is a legal document all details on the form must be completed. Incomplete forms will not be approved. Applicant is required to complete the section on the left side of the application, specify name, contact details etc. Council or Community organisation to complete section on the right hand side of the application form. of identity of the applicant, photograph or driver’s licence must accompany the application. Evidence of support is required from persons accepted by the majority of the community or group to be its leaders. This can be supplied in the relevant section of the application form. A map depicting the proposed area in which fishing will occur must be submitted with the application. The application fee may be paid by the following methods: Direct Credit Transfer Cash Cheque EFTPOS Credit Card Declaration Under Section 35 of the Northern Territory Fisheries Act making false or misleading statements in applications is an offence Changes to legislation Please note that the Fisheries Act, regulations and management are amended from time to time. Current versions of these documents are available on the Internet and may be viewed at nt.gov.au. Office Address: Goff Letts Building Berrimah Farm Makagon Road BERRIMAH Tel: 08 89992183 Fax: 08 89992057 Email: Postal Address Fisheries Licensing Department of Primary Industry and Resources GPO Box 3000 DARWIN NT 0801 Privacy Statement: Details in this application will be recorded in a Fisheries Register and certain personal details may be released but, will only be done so in accordance with S9 of the Fisheries Act. NORTHERN TERRITORY FISHERIES ACT (Part 11 Division 2 – Fisheries Regulations) APPLICANT’S DETAILS COUNCIL/COMMUNITY ORGANISATION
APPLICATION FOR API 14A VALIDATION TEST CONTACT INFORMATION Application Date: Manufacturer: Revision No.: Representative: Test Agency: Southwest Research Institute® Address: Address: 6220 Culebra Road San Antonio, TX 78238 (210) 522-2335 Contact(s): (210) 522-6638 (Fax) Quick Test P.O. # or W.O. #: (7-Day Turnaround) (Expedite Fee Applies) VALVE INFORMATION Serial Number: Nominal Tubing Size: Rated Working Pressure: psi Valve Type: and Test Section Length: inches Retest: If yes, previous SwRI Test Number: For SCSSV Only: Maximum hydraulic control line pressure: psi Maximum unequalized opening pressure differential: psi Minimum specified ID: inches Maximum specified OD: inches Drift Bar – Unique ID: OD: inches Length: Drift Sleeve – Unique ID: ID: inches Length: Tubing pressure insensitive: Yes No For Only: Velocity Type: Water Closing Rate: B/D Gas Closing Rate: MMscfd Tubing Pressure: Closing Pressure: psig For Only
Commercial and Private Agents Licensing Act Please in block letters. If there is insufficient space, attach extra sheets. All questions must be answered and full particulars provided. Once this application form is complete it must be lodged at a Territory Business Centre with the prescribed fee. For any enquiries relating to this application please contact (08) 8999 1800 Application for Approval for an Agents Manager 1. Licence Details Licensee name Licence number Expiry date Licence category held: Commercial Agent Private Bailiff Inquiry Agent Process Server Business address 2. Applicant details Title Mr Mrs Ms Miss Surname Given name(s) Date of birth Street address Postal address Telephone Facsimile Mobile Email 3. Declaration by employer This section is to be completed and signed by the authorised nominee of the licensee where the applicant is to be employed. I, (insert name of authorised nominee)