zilongwang/ReadingBank huggingface dataset:
SPF PFS Application Form to Substitute Community-Level National Outcome Measures (NOMs) Data 1. Contact Information Name of the applicant (first and last name): Title: Mr. Ms. Dr. Other _____________________ PFS Position: Organization: Department: Mailing address: E-mail address: Telephone: Fax: Does this request apply to all PFS funded subrecipients? Yes No (indicate the number of subrecipients that are requesting this NOM substitution) _____________________ 2. Measure Labels and Reported Outcome Label of the NOM(s) indicator for which the grantee is requesting a substituted proxy measure (e.g., 30-day use of alcohol): wording of the proxy measure and response items the grantee is requesting to substitute for the NOM(s) – for example, “One how many occasions (if any) have you had alcoholic beverages (beer, wine or hard liquor) to drink – more than just a few sips – during the past 30 days: 0 occasions, 1 or 2 occasions, 3 to 5 occasions, 6 to 9 occasions, 10 to 19 occasions, 20 to 39 occasions.” Exact wording of the outcome that will be reported to SAMHSA/CSAP – for example, “Percent who reported having used alcohol during the past 30 days.”
Formulae for calculating or deriving the prevalence estimate (reported outcome) – for example: Recode any response indicating use on at least one occasion as having used during the past 30 days. 3. Narrative Justification Provide a summary of how the collection and reporting of community-level NOMs was written in your approved PFS Strategic Plan. Does the requested substitution differ from what was written in your approved PFS Strategic Plan? If yes, why? Provide a description of the reasons for the substitution. Justification should include evidence that new data collection or the modification of an existing data collection effort necessary for reporting an approved NOM was investigated and deemed unviable.
Chinese, Chinese Scottish or Chinese British Any other Asian, (please write in) Mixed or Multiple ethnic group ethnic group Any Mixed or Multiple ethnic groups, (please write in) Arab, Arab Scottish or Arab British Any other ethnic group, (please write in) Section 7 – Religion or Belief What is your religion or belief? No religion or belief Buddhist Sikh Prefer not to say Christian Hindu Pagan Jewish Muslim Another religion or belief (please say what)
If Yes, please provide details: If you are successful in your application, would you require a work permit prior to taking up employment? □ Yes □ No Current Salary: Notice Period: Criminal Convictions Declaration and Fitness to Practise Proceedings The successful applicant will be required to obtain a Protection of Vulnerable Groups Certificate demonstrating suitability to undertake regulated work with children and adults. We also need to establish if you have been the subject of any fitness to practise proceedings in the past, or any fitness to practise proceedings are being contemplated, by a licensing or regulatory body in the UK or another country. This information will be treated in confidence and will not debar you from appointment unless the selection panel considers that it renders you unsuitable for appointment. To the best of your knowledge have you been or are you currently subject to any fitness to practise proceedings by an appropriate licensing or regulatory body in the UK or any other country? □ YES □ NO If yes, please provide details of the nature of proceedings undertaken, or contemplated, including approximate date of proceedings, country where proceedings
were undertaken and the name and address of the licensing or regulatory body concerned. Please enter text here: Data Protection Statement The information provided by you on this form and any supplementary forms will be used to assist with the process of recruiting in accordance with the Mental Welfare Commission for Scotland Recruitment & Selection Policy. If you are successful in your application, the information will be used for HR records and payroll purposes. By signing the declaration below, it is understood that you consent to the use of your personal information for the above purposes. Declaration I confirm that the information given on this application form and on any additional sheets submitted is, to the best of my knowledge, correct. Do you agree to the statement above? □ Yes □ No Signature: Date:
Employment / Professional suitability This information will be taken from Section 3. Unless you record a specific objection in Section 3, we reserve the right to communicate with any of your past and current employers. You may also provide the name and address of a person, other than previous employers, who will be able to comment on your academic/technical capability/work experience (for example, a supervisor, tutor or colleague). 5. Personal Profile and Experience What skills and knowledge specific to this role can you offer? (please refer to job description/person specification) Please also include any relevant achievements applicable to this post. 6. What are your reasons for applying for this post?
Position applied for: Section 1: Personal details Title: Dr/Mr/Mrs/Miss/Ms Forenames: Surname: Former name: Preferred name: Date of Birth (required for section 9): Teacher’s Reference number (TRN) (if applicable): National Insurance Number: Current Address: Postcode: Telephone number(s): Home: Work: Mobile: Email address: Previous Address (if resident at current address for less than 5 years): Postcode: Have you ever been convicted of a criminal offence? Yes No If yes, please provide details: Is there any relevant court action pending against you? Yes No Are you eligible for employment in the UK? Yes No Please provide details: Do you have Qualified Teacher status? Yes No If you are offered, and accept, a position at Merchant Taylors’ Prep would you continue in any other form of employment? Yes No If yes please give details (Please note it is school policy not to allow members of teaching staff to continue in any other form of employment). Permission may only be granted by the Head in exceptional cases.
With whom does your child normally live: Please insert name, address and telephone number if different from above Are any of your other children attending ? If so please complete this box: NAME: TUTOR GROUP: Lunch Arrangements (please tick as appropriate) Lunch at home Takes school lunch Brings packed lunch Free meal MEDICAL ARRANGEMENTS Name of Family Doctor: Practice: Address: TELEPHONE NUMBER: Does your have any medical conditions of which you wish the college to be aware (for example – asthma, allergies)? If Yes please give details: Does your child have a Health Care Plan? YES / NO Travel Arrangements (please tick as appropriate) School coach Public transport bus Taxi Train Bicycle Private car ETHNIC AND CULTURAL INFORMATION
Application Form Position Applied For: How did you find out about this position? (if through advertisement please state where) Personal Details Surname: Forename(s): Title: Former Name: Preferred Name: Telephone no (Home): Address: Telephone no (Work): Telephone no (Mobile): Town: Email Address: County: National Insurance No: Post Code: Date of Do you have Qualified Teacher Status? Yes or No? DCSF number and date qualified: Do you have the right to work in the UK? Yes or No Have you read the School’s Protection Policy available on our website (www.kgs.org.uk) Yes/No Education – please with most recent Name of school/college/university Dates of attendance Examinations Subject Result Date Awarding body From: dd / mm / yy To: dd / mm / yy From: dd / mm / yy
Lead assessor: Technical assessor: Technical assessor: Technical assessor: Expert: Observer: 4. General Requirements Comments on document review Documented in quality system: 4.1 Legal and contractual matters 4.1.1 responsibility The certification body shall be a legal entity, or a defined part of a legal entity, such that the legal entity can be held legally responsible for all its certification activities. NOTE A governmental certification body is deemed to be a legal entity on the basis of its governmental status. 4.1.2 Certification agreement 4.1.2.1 The certification body have a legally enforceable agreement for the provision of certification activities to its clients. Certification agreements shall take into account the responsibilities of the certification body and its clients. 4.1.2.2 The certification body shall ensure its certification agreement requires that the client comply at least, with the following: a) the client always fulfils the certification requirements (see 3.7), including implementing appropriate changes when they are communicated by the certification body (see 7.10); b) if the certification applies to ongoing production, the certified product continues to fulfil the product requirements (see 3.8); c) the client makes all necessary arrangements for 1) the conduct of the evaluation (see 3.3) and surveillance (if required), including provision for examining documentation and records, and access to the relevant equipment, location(s), area(s), personnel, and client's subcontractors; 2) investigation of complaints;
Name(s) and qualifications: List all names and qualifications within the organization, if applicable. Experience: Clearly demonstrate your experience in the delivery of similar native vegetation management projects, including the management of SEB Areas. Referees List the details of two referees. Referee 1 name: Organisation: Relationship to applicant: Address: Postcode: Phone: Email: Referee 2 name: Organisation: Relationship to applicant: Address: Postcode: Phone: Email: Bona fides
make provisions, where applicable, to accommodate the presence of observers (e.g. accreditation assessors or trainee auditor); documents describing the rights and duties of certified clients, including requirements, when making reference to its certification in communication of any kind in line with the requirements in 8.3; f) information on processes for handling complaints and appeals 8.5.2 Notice of changes by a certification body The certification body give its certified clients due notice of any changes to its requirements for certification. The certification body shall verify that each certified client complies with the new requirements. 8.5.3 Notice of changes by a certified client The certification body shall have legally enforceable arrangements to ensure that the certified client informs the certification body, without delay, of matters that may affect the capability of the management system to continue to fulfil the
Flexible Care Only answer the following questions if you are seeking approval to provide Flexible Care restorative care) under the Act. ! Before responding to the questions below, refer to section 106A of the Subsidy Principles 2014 for information about the different kinds of flexible care. Provide a statement that outlines your organisation’s experience providing: restorative care that would meet the objectives of delivering flexible care in the form of short-term restorative care; and/or other kinds of flexible care including flexible care delivered through a multi-purpose service, innovative care service or transition care. If you have no relevant experience, write ‘Not Applicable’. Describe the policies and procedures you will implement to meet the relevant standards the Act and Principles and to effectively deliver short-term restorative care. Describe how you will: provide statements for services delivered through the program ensure appropriate care planning/delivery that meets program requirements track any daily fees that a care recipient may be required to pay measure and record changes in a care recipients functional status if required by the program Describe the concept of multi-disciplinary teams in the delivery of short-term restorative care, and the policies/procedures (if any) you will implement.
F. ADVISOR LETTER OF SUPPORT The faculty member listed as the advisor for your scholarly activity must submit a letter of support on your behalf. The letter must include discussion of the following: How long and in what way(s) does the faculty member know the applicant. The nature of the faculty member’s role(s) in the activity, including an estimate of his/her personal contribution (e.g., 75% student; 25% faculty member). The applicant’s work ethic, abilities, and qualifications to complete the proposed activity. G. POSTER REQUIREMENTS Format The format of posters submitted to the library vary by activity. Examples of previous winners can be viewed in the library. Your poster should at least incorporate a title, the name(s) of the student(s) and faculty member(s) involved, a summary of the project (e.g., items found in your narrative), and a discussion of your results (when possible). Recognition Your poster should include the following statement and logo: Partial funding for this project was provided by a Friends of the Baron-Forness Library Scholarly Activity Award. Size - Preferred size is (36 inches x 48 inches). - Piper Press (105 Dearborn Hall; x2739) requires a PDF file SET TO THE DESIRED SIZE. That is, do not submit and 8.5” x 11” file and expect it to be resized. Rather, in PowerPoint (or whatever application you’re using), set the desired size first. Then, create/layout your content and save the file as a PDF file. - Posters should be in color and laminated. - It is acceptable to submit a poster you’ve used previously (e.g., conference presentation, Celebration of Excellence) - Posters must be presented to the library prior to September 15 following the Recognition Event. SUBMISSION Questions and completed applications (both narrative and cover pages) should be directed to: Dr. Monty L. McAdoo Baron-Forness Library, Rm. 128 mmcadoo@edinboro.edu 814-732-1070
Please indicate the type of licence which you are applying for … Application for a Licence Application for a variation of an existing Licence Renewal of a Licence Please indicate the type of property for the application is being made … House in multiple occupation Flat in multiple occupation Property converted into units of accommodation which are not flats [although there may also be self-contained flat(s)] Please indicate how the HMO is operating … Shared facilities Bedsits with some shared facilities A dwelling-house with lodgers A hostel Supported lodgings PART 2: DETAILS OF PROPOSED LICENCE HOLDER 2.1 Name and address of proposed licence holder: The address provided for an individual should be their permanent residence address and adequate proof must be provided. Examples would include: driving licence; recent bank or building society statement or recent tax correspondence; recent utility bill. Mr Mrs Miss Ms Other Last name: First name: Residential address: Postcode: Home telephone no: Work telephone no: Mobile telephone no: e-mail address: Proof of address enclosed: Interest in property: contained
Application for enrolment in BENGAL TENNIS ACADEMY in association with Bengal Tennis Association (for 5yrs to 9 yrs) ⃝ ⃝ Name - Male/ Female- Father’s name - Mother’s name – Occupation of parents- Annual monthly income- Date of Birth (provide authentic Birth certificate) Permanent Address (provide proof of residence) Address (if any) Mobile no- Landline no Name of School- Class - School Timings- Weekly Holidays Please Tick appropriate ⃝ ⃝ Have you ever played Tennis - Yes/ No If yes, where have you played – How many years have you played- Any notable performances in any tournament played If selected, when can you make yourself available for training purpose at Kolkata ( to start with) Please tick ⃝ ⃝ ⃝ ⃝ ⃝ Weekdays Monday/ Tuesday/ Wednesday/ Thursday/ Friday ⃝ ⃝ Weekends Saturday / Sunday Signature of Parent Signature of student There will be a selection trial to be held at Kolkata (dates to be notified later). Candidates may be called more than once to Kolkata for selection trials. Initially (first 3 months) the selected candidates will be assembled at Bengal Tennis Association, Salt Lake on weekends. In future are plans to open centres at Durgapur/ Serampore/ Midnapore/ Bankura . CANDIDATES WILLING TO APPLY MAY PLEASE DOWNLOAD THE ABOVE APPLICATION FORM FROM THE BTA WEBSITE – AND SEND THE SCANNED COPY OF FILLED FORM TO OR PHYSICALLY SUBMIT IT TO BENGAL TENNIS ASSOCIATION, SECTOR – 3, YUBA BHARATI KRIRANGAN(BESIDE GATE NO 2) SALT LAKE, KOLKATA – 700098 FROM 12.30 PM TO 4.30 PM- MONDAY – SATURDAY. LAST DATE OF APPLICATION –
D. HAS A LAWSUIT BEEN FILED AGAINST THE SPONSORING INSTITUTION DURING THE PAST 24-MONTH PERIOD? Yes No If yes, explain (including an explanation of its status): 5. PROGRAM INFORMATION: Complete the below for each Surgical Technology program credential level. (Hover then click on the plus sign [ + ] at bottom right corner of the table below to add more rows.) Program Name In Class Clock Hours Recognized Outside Hours* Total Clock Hours Number of Instructional (D-Day; E-Evening; &/or Weeks (D-Day; E-Evening; &/or Weekend-W) Academic Credit: Quarter Semester Delivery Method** (residential; blended; or full distance) Credential Awarded (Diploma, Certificate, or Type of Degree) Do not use abbreviations *Recognized Outside Hours: The ‘Recognized Outside Hours’ (i.e., student preparation, homework) column is NOT applicable to clock-hour only programs; thus, the column must be marked ‘N/A’, and the hours noted in the ‘In Class Clock Hours’ column and in the ‘Total Clock Hours’ column must be the same. IMPORTANT: Recognized outside hours are based upon required academic clock-to-credit-hour conversions described in standard IV.G.1 of the ABHES . For institutions awarding credit for outside class hours will be required to provide a detailed analysis of how these hours were derived, how they complement the given coursework, and how students benefit from the respective assignments during the on-site evaluation visit. **Delivery Method: See definitions in the Glossary of the . IDENTIFY THE APPROPRIATE SIX (6) DIGIT CLASSIFICATION OF INSTRUCTIONAL PROGRAMS (CIP) CODE PER THE U.S. DEPARTMENT OF EDUCATION FOR THE SURGICAL TECHNOLOGY PROGRAM(S). TO VIEW LIST OF CIP CODES, (Hover then click on the plus sign [ + ] at bottom right corner of the table below to add more rows.) Program Name CIP Code
GENERAL EDUCATION / LIBERAL ARTS COURSES: Course Number Course Title Course Hours Number of Credit/Clock Hrs. in Specialty Courses: / Percentage: Number of Hrs. in General Courses: / Percentage: If applicable: Number of Credit/Clock Hrs. in Liberal Arts: / Percentage:
Are you free to remain and take up employment in the UK? Yes No DISABILITY If you have a disability and are invited to sit a test or attend an interview would you like any special arrangements made? If so, please give details below: EDUCATIONAL AND PROFESSIONAL QUALIFICATIONS Subject Type of Qualification eg GCSE, Standard Grade, Higher, Degree Attainment MEMBERSHIP OF PROFESSIONAL REGULATORY BODIES Name of Organisation Registration Number/Level of Membership Renewal Date EMPLOYMENT HISTORY PRESENT EMPLOYMENT Employer (Name, Address and Nature of Business) Jobs Held/Key Achievements
Institutional Review Board Southwestern Assemblies of God University Application for Approval of Research Involving Human Subjects: Student Researcher as Principal Investigator Section 1: Preliminary Information Principal Investigator/Faculty Sponsor Date of Submission: Submitted by: Title of Project: Directions to the Faculty Sponsor: Submit the completed application either electronically or in hardcopy to the SAGU Institutional Review Board (IRB). Work closely with the principal investigator (PI) to ensure that all
Month/Year Month/Year / / / / / / 4.4. Professional Experience Position/Job Title Employer Start Date Month/Year End Date Month/Year / / / / / / / / / / 4.5. Language Skills Language Understand Speak Read Mother language: Elementary Good Very good Elementary Good Very good Elementary Good Very good Elementary Good Very good Elementary Good Very good Elementary Good Very good Elementary Good Very good Elementary Good Very good Elementary Good Very good Elementary Good Very good Elementary Good Very good Elementary Good Very good 4.6. Engagement in Church and Motivation Please give us a short overview of your previous and/or current services in the church (volunteer, committees, etc.).
8. MEMBER & HIS/HER FAMILY DETAILS (BLOCK LETTERS) :- RELATION NAME D.O.B AGE BLOOD GROUP APPLICANT / / WIFE / HUSBAND / / SON / / SON / / DAUGHTER / / DAUGHTER / / Membership of other professional Institutions If yes, Please furnish details Membership No./Validity OR 12. RECOMMENDATION BY CHAPTER - 5
EMPLOYMENT DETAILS B.1 CURRENT EMPLOYMENT STATUS Please tick the correct status of employment Permanently Employed Not Permanently Employed Self Employed Other, Please specify: Current/Most Resent Employer Name Position/Job Title In The Organization Period Of Service (attach certified copy of service letter) From: Till: Employer Physical Address Street City/Town Postal Code Municipality Postal Address PO Box City/Town Postal Code Province E Cape N Cape W Cape FS KZN Mpumalanga Limpopo Gauteng N West Contact Details (Reference) Contact Person Position Phone No. Cell No. E-mail Fax No B.2 Previous Employer Name Position/Job In The Organization Period Of Service (attach certified copy of service letter) From: Till: Contact Details of manager or supervisor Contact Person Position Phone No. Cell No. E-mail Fax No
Technical Qualification Relevant To The Trade (attach certified copy) N2 Other, Specify: Yes No Tertiary Qualification Relevant To The Trade (attach certified copy) If YES, Specify: No 2.4 Additional Training Relevant To The (attach certified copies of certificates e.g. safety) If YES, Specify: No Workplace and Theoretical Evidence (On-The Job) Experience (Please tick relevant evidence you submitted) 3 Relevant On-The-Job Experience With CHIETA N2 Equivalent: 3.2.1 Certified Copies Of Service Letters Demonstrating A Minimum Of 3 Year relevant Experience and 3.2.2 Certified CHIETA N2 (4 Subjects) Equivalence Statement Of Results; OR Yes No 3 Relevant On-The-Job Experience With Full N2 certificate(4 Subjects) : 3.3.1 Certified Copies Of Service Letters Demonstrating A Minimum Of 3 relevant Experience and 3.3.2 Certified Copy Of N2 (4 Subjects) Or Higher Relevant To The OR Yes No 3.4 3 Years Relevant Working Experience With Relevant Engineering NCV at NQF Level 3 3.4.1 Certified Copies Of Service Letters Demonstrating A Minimum Of 3 relevant Experience and 3.4.2 Certified Copy Of NCV at NQF 3 Trade Related Qualifications; OR Yes No 3.5 18 Months relevant working experience plus completion of all relevant work experience modules with a Relevant NC(V) 4 3.5.1 Certified Copies Of Service Letters Demonstrating A Minimum Of 18 Months relevant Experience and 3.5.2 CERTIFIED Copy OF NC (V) Level 4 TRADE Related Qualification; OR Yes No 3.6 3 Years Relevant Working Experience With Technical Grade 12 with Maths, Engineering Science and Relevant Trade Theory Subject 3.6.1 Certified Copies Of Service Letters Demonstrating A Minimum Of 3 Or More Years relevant On-The-Job Experience and 3.6.2 Certified Copy of Grade 12 Report or Certificate with Maths, Engineering Science and Relevant Trade Theory Subject Passed; OR Yes No 3.7 4 Working Experience With Grade 9 With Maths : 3.7.1 Certified Copies Of Service Letters Demonstrating A Minimum Of 4 Or More Years relevant On-The-Job Experience and 3.7.2 Certified Copy of a Grade 9 report with Maths passed; OR Yes No 3.8 18 Months relevant working experience With relevant N6 certificate or National Technical Diploma ( S or N stream): Yes No
Stimulants: Lighter Fuels Paint Spray Cocaine Cocaine Crack Ice Meth Nicotine- Tobacco: Cigars Cigarettes Snuff Caffeine Energy drinks Coffee Ritalin Amphetamine Mescaline Speed Other: What is your drug of choice: __________________________________________________________________ of the following areas have been negatively affected by your use: School Attendance  Family Relationships  Physical Health  Employment  Psychological Health  Situation  Other:____________ Do you think you have an alcohol and/or drug use problem? Yes  No  Are others concerned your alcohol &/or drug problem? Yes  No  Have you ever attended Narcotic &/or Alcoholics Anonymous meetings (AA or NA)? Yes  No  If Yes, did you have an AA/NA sponsor? Yes  No  Number of AA or NA meetings attended in the past 6 months: _____________ Do you have any following addictions?
Gambling  Relationships  Shopping  Sex  Food  Internet  Other: ______________________________ Impact: Which areas have been negatively affected by your use? School Attendance  Physical Health  Family Relationships  Legal Situation  Employment  Psychological Health  Friendships  Parenting  Other ____________________________________________________________________________________ Situation: Did you drink or use drug… Alone  With boss  With parents  With Cousins  At home  With Co-workers  With Grandparents  With Uncles-aunts  At parties  With Strangers  With Spouse  On weekdays  In bars  In large groups  With Brothers/Sisters  On weekends  At work  With small groups  With Friends  Family of Origin use History: Is there any history of alcohol/drug use in your family of origin? Yes  No  Relatives Uses alcohol Uses Never met this relative Deceased. Year of death: In close contact Some contact No contact Grandmothers: Grandfathers: Bio Mother Adoptive Mother Bio Father Adoptive Father Foster Parents Brothers: Sisters: Children: Risk Assessment:
How did the client hear about SSAFA? How did the client hear about Stepping Stone Homes? Has the client viewed the Stepping Stone Homes’ web page? Yes/No 10. Signature of Client Date 11. REFERRER DETAILS Name Position Address Tel No Fax No Email: Will the referrer accompany the service user to SSH? Yes/No Signature Date 12 AUTHORISATION - by SSAFA ONLY. Authorising Signature Date
Name and address of present or most recent school: LA Name and address: ( if applicable) E-mail: Date employed from: Date employed to: Telephone: Employment background Please detail chronologically all previous work experience, unpaid and paid, voluntary, non-teaching as well as teaching, since leaving secondary/further education From month/ year To month/ year of work/employer (if applicable) Scale/ grade Title/ responsibility Reason for leaving Have you ever been dismissed by any of the above employers? If yes, further details may be requested from you Yes No Education background Secondary education Name of institution From To month/year Qualifications obtained (Please indicate level, subject(s), grades and dates of award) Further, higher and professional education (Proof of qualifications will be required) Name of institution From To month/year Qualifications obtained (Please indicate level, subject(s), grades and dates of award)
My present employment: (I currently work for the Council): Yes No My disability status: (please read the definition over the page before answering) I am not a disabled person I consider myself a disabled person My age: 16-19 20-29 30-39 40-49 50-59 60-64 65 + My religion: Christian (including Church of England, Catholic, Protestant and all other denominations) Sikh Muslim Hindu Buddhist Jewish None Any other religion – please write in box My caring responsibilities: I look after children I help an adult with her/his daily routine For Office Use Only Part-time Full-time Permanent Fixed term Interviewees Candidate(s) No NC selected
NGR coordinates (eg. NG 1234 5678) Any planned expansion in the next year? If yes, provide details. Yes No Anticipated date of first harvest: Is this site within a currently classified production area? If so, please provide details. (Area, Site & SIN) Yes No If no, has this site been previously classified? Yes No Please note: Classification of a shellfish harvesting area does not confer the right to harvest shellfish. Permissions may also be required from other bodies (e.g. Local Authority, Crown Estate, Scottish Natural Heritage, land owner, Marine Scotland). The applicant is responsible for obtaining these. Has the required razor licence been obtained in advance of sampling towards classification? (Razor Clam areas only) If yes, please provide details. Yes No Have planning permission and Crown Estates lease been obtained for the site? (aquaculture only) Yes No Has growing equipment been installed at the site? If yes, provide details. If no, provide details and date of anticipated installation. (aquaculture only) Yes No Is the area subject to seasonal conservation controls? If yes, provide details. Yes No SPECIES TO BE HARVESTED Wild or Farmed? Growing method (e.g. bed, trestle, rope) Harvesting method (e.g. hand, dredged, dived) Season (e.g. year round or specify season) Shellfish species Pacific oyster Crassostrea gigas Common mussel Mytilus spp. Native oyster Ostrea edulis
Signature: ________________________________ Date: _______________________
5. ACTIVITIES- list any sports or other organizations with which you have been involved with in or out of school. (Possibilities include Scouting, church groups, or community service organizations.) 6. INTERESTS- List three things that you like to do in your spare time. In other words, tell us a bit about yourself. 7. CURRENT SCHEDULE- What classes are you currently enrolled in and what grades do you think you are receiving in those courses? What courses do you hope to take next year? THE ENTIRE APPLICATION MUST BE FILLED OUT BEFORE REVIEW. EACH APPLICATION MUST HAVE TWO COMPLETED RECOMMENDATION FILLED OUT BY FORMER OR CURRENT TEACHERS, SEALED IN AN ENVELOPE AND ATTACHED TO THIS APPLICATION. My signature below indicates that I give my consent to my son/daughter to register for the Medical Science Academy at Valencia High School. Questions, please contact Mr. Monteleone at Valencia High School at 661-294-1188 x 707 or email at _____________________________________DATE_______________ PARENT‘S/ GUARDIAN’S SIGNATURE
Total points achieved in Leaving certificate. My Third Level Qualifications are: Dates College Degree details (subjects each year – specify final year subjects) Degree result (ie 1.1, 2.1 etc) My Teacher Education Qualifications are: Dates College Examination – overall result of qualification Teaching practice result in final placement Additional Professional Qualifications (Certificates/Diplomas or Training)
Employer Name, contact person & phone number Workplace location (South, North, North West) Apprentice/ Trainee name, date of birth & Qualification Code e.g. Tom Brown (BSB30415) Employment status (full-time or part-time) Previous qualifications? (Please provide details). Does the proposed apprentice/ trainee meet the User Choice eligibility criteria? (Yes/No) Is this qualification required for licensing or compliance purposes? **Is there strong support from the employer and how will the training benefit the workplace? Add more lines by ‘tabbing’ across table. **If the RTO is the preferred provider for an employer, this should be noted in final column above and must be evidenced by an attachment. INFORMATION FOR RTOs REGARDING THE APPLICATION PROCESS:
convictions and/or record) from this Bureau and any offer of employment will be subject to a satisfactory disclosure being received. Back to top RELATIONSHIPS You must disclose any personal relationships with an Erewash Borough Councillor or Employee of the Council on the back of the application form. FINALLY - AT THE INTERVIEW If you have been invited for an interview, here are a few tips that might help you: Prepare yourself – maybe there is more you could find out about the job or the organization - visit our website – www.erewash.gov.uk - or for certain posts, things that you have produced or worked on that you could take along to show the panel, perhaps to support your application. Arrive on time – the last thing you want is to feel rushed and harassed when you go into the interview. Check the location of the interview – the council has offices on a number of sites. Settle yourself down and make yourself comfortable. When asked a question, give yourself time to think about it before you answer. You be asked questions about: yourself, your experiences, your qualities and skills that you would bring to this job, your application form and probably some questions to test your approach and expertise in a particular area of activity. Some interviews may include a test, or ask you to make a presentation. In such cases you will be given the necessary details when invited to attend for interview. At the end of the interview, you will be asked if you have any questions - don’t be afraid to ask! However, there’s no obligation to ask questions so equally don’t feel you have to! We want to ensure that applicants are treated fairly, even if they are not appointed. If you feel you have been unfairly treated, you have the of complaint. If you wish to take up this right, you must do so in writing to the Head of Personnel stating why you feel you have been treated unfairly. Any complaint should be made as soon as possible and no later than 14 days after you were informed of the result of your application.
Application form for request of review of educational materials Please fill in the applicable information, tick the appropriate boxes and submit the application form along with relevant documents, by e-mail to IMA (email address: , subject: EDUMAT followed by the medicinal product name). Request for initial review (new/first- time educational materials) Request for repeated review (updated educational materials) Only the Icelandic version of the materials should be submitted but IMA may request the English version if necessary Medicinal product name, active ingredient, strength and pharmaceutical formulation: Original product Generic/biosimilar Marketing Authorisation Holder: Agent (if applicable): Name, e-mail address and phone no. of contact person: Date of planned marketing of the medicinal product (if not already marketed). dd/mm/yy: Date of planned distribution/publication of the educational materials. dd/mm/yy: Clarification of the main amendments/changes of the updated educational materials (repeated submission only): List of all components of the educational materials: Cover-letter (required), List of proposed recipients (by speciality not on a name basis):
Year 1 Year 2 Ongoing VRS Payment (-) from table 1 if applicable MEP (-) from table 1 Savings on staff costs (+) From 2 if applicable Extra costs from regradings/change in hours (-) from table 3 if applicable Extra costs from new posts (-) from table 4 £ £ £ 6. Explain below/attach the case for making the post(s) identified above redundant, and requesting approval for any new cases. Include the following information: any proposed restructuring the potential impact on other staff, and how this will be managed confirmation that the department will meet its strategic objectives and cover its core activities if the post is externally funded, how contractual obligations to sponsors will be met Supporting evidence attached: from online VRS calculator confirming costs
(CBNU) Baekjedaero 567, Jeonju, Jeollabuk-do, 561-756, Republic of Korea Tel: +82-63-270-2248 Fax: +82-63-270-2099 E-mail:Feelingkorea@chonbuk.ac.kr Website: APPLICATION FOR THE FEELING KOREA PROGRAM Name ____________ ___________ First Name / Family Name Nationality Passport NO Date of Birth _______ _______ _____ yyyy / mm / dd Gender □ Male □ Female E-mail Cell Phone University Course □ Undergraduate □ Master □ Doctor Major Grade Date of Participation □ 1st : 1.11~1.22 □ 2nd : 1.25~2.5 □ 3rd : 2.15~2.26 Field Trip □ Temple Stay □ Amusement park □ I don’t attend any field trip. Special Culture Experience program (For 2nd participants only) 1st choice_________ 2nd choice__________ 3rd choice_________ ※ special cultural experience: Taekwondo, Korean dance, Korean paper art, Traditional Korean Music, history exploration ※ The number of students for each program is limited to 30. If it exceeds 30, students who late will be allocated to Second choice or Third choice program. ※ After participating the brief class sessions, you are able to change your application. Parents participation □ No □ Yes(Mother) □ Yes(Father) □ Yes(Mother & Father) Language Proficiency English □ Advanced □ Intermediate □ Beginner Korean □ Advanced □ Intermediate □ Beginner I hereby certify not only that the information provided above is complete and accurate but also that if accepted by Feeling Korea Program I shall abide by the regulations of CBNU and laws of Korea. Date : ________________ Signature : ______________
Vacation of Easement $130.00 Road (Vacation) Closures $130.00 Site Plan Review $425.00 Special Approval: Car Tent Sales Permit $500.00 Beverage License Review $150.00 Temporary Beverage License (1 to 3 days permit) Review $25.00 Nuisance Abatement Fees Standard Abatement ($25.00 per hour) TBD (To Be Determined) Noticing, Abatement involving asbestos (cost of the Asbestos Survey includes an additional fee) Document or Map Purchases Zoning Text per County policy Comprehensive Plan (text) $35.00 Evaluation & Appraisal Report Document $ 125.00 Maps (each FLUM or other map) $20.00 Blueprint Maps (each FLUM or map “32 x 32”) $ 10.00 Blueprint Maps (each FLUM or other map “24 x 36”) $ 5.00 Copies or Xerox charges – one sided per County policy Copies or Xerox charges – two sided per County policy Computer Discs with information per County policy Cassette tape – 90 minutes per County policy Computer Disc without information per County policy Garage Sale/Yard Sale Permit ***Note $ 5.00 Vesting Order Applications Single Lots of Record $ 175.00 Subdivisions ( under 26 units) $425.00
EUROPRACTICE STIMULATION ACTIONS for FIRST USERS of chip design in MEMS or Si-photonics technologies EUROPRACTICE Axxxxx membership number : University Name and Faculty : Name of Professor/Advisor : Name of student(s) : Program of the student(s) : Contact Email address : FULL APPLICATION DESCRIPTION OF PROPOSED DESIGN Short name of project: Stimulation Program : Technology to be used : Application field: Design methodology: Main characteristics: Novelty: Teaching/research evolution by your institute:
5. REFERENCES Please give details of two referees who are not related to you. The referee must be your current or most recent employer. (If you have been self-employed, this referee should be able to comment on your work). If you have not previously been employed, this referee should be able to comment on your experience/ performance as a student/ pupil. The second referee can be a past employer or someone that you have known for a minimum of 12 months. References are not normally taken up until we have decided to invite you to an interview. Referee 1 – Current/ most recent employer (if applicable) Name (including title) Job title or status Organisation Capacity in which you know this person Postal address Postcode Telephone number E-mail address This person can be approached prior to interview Yes No (Please tick as appropriate) Type of Reference (please indicate) Employer Academic Referee 2 Name (including title) Job title or status Organisation Capacity in you know this person Postal address Postcode Telephone number E-mail address This person can be approached prior to interview Yes No (Please tick as appropriate)
We are pleased that your student is interested in participating in the 2018 District Attorney’s Justice Academy. Admission to this Academy is an honor and we expect each participant to attend each Justice Seminar at the Alameda County Board of Supervisors Chambers in Oakland twice monthly from 4:00-6:00pm and all summer internship hours. All seminar dates are listed on the program application. If your son/daughter is unable to attend a Seminar and/or work due to illness, he/she is required to call staff ahead of time. This form is to be completed and submitted with the program application in order for the applicant to be considered for admission. Parent/Guardian: Sign below to demonstrate that you have read and understood the program requirements. I have reviewed the Justice Seminar dates on the program application and confirm that my student will attend the Seminars twice monthly from 4:00-6:00pm at the Alameda County Board of Supervisors Chambers in order to continue participating in the Justice Seminars and be eligible for the paid summer internship. I confirm that my student is available to work all summer internship from Monday, June 11th or June 18th (depending on your child’s last day of school) to Friday, July 6th or July 13th 2018 (depending on your child’s internship start date). I understand that failure to participate in the Justice Academy Seminars, work hours, and closing ceremony could result in my student’s termination from the District Attorney’s Justice Academy. Parent Name (Print): Parent Signature: Date: Student: Sign below to demonstrate that you have read and understood the program requirements. I have reviewed the Justice Seminar dates on the program application and confirm that I will participate in the Justice Seminars twice monthly from 4:00-6:00pm at Alameda County Board of Supervisors Chambers in order to continue participating in the Justice Seminars and be eligible for the paid summer internship. I confirm that I am available to work all summer internship hours from Monday, June 11th or June 18th (depending on your last day of school) to Friday, July 6th or July 13th 2018 (depending on your internship start date). I understand that failure to participate in the Justice Academy Seminars, work hours, and closing ceremony could result in my termination from the District Attorney’s Justice Academy. Student Name Student Signature: Date:
Marking Rubric ______ / 30 Marks Summary of Research: ________ / 16 Marks Category 4 3 2 1 Clarity and Neatness Easy to read and all elements are clearly written labeled, or drawn. Easy to read and most elements are clearly written, labelled or drawn. Hard to read with rough drawings and labels. Hard to read and one cannot tell what goes where. Mechanics – spelling & grammar No spelling or grammatical mistakes. Spelling/or grammatical error does not affect understanding of project. Several spelling and/or grammatical error. Spelling/or grammatical error affects understanding of project. Content All content is in the students’ own words and is accurate. Almost all content is in the students’ own words and is accurate. At least half of the content is in the students’ own words and is accurate. Less than half of the content is in the students’ own words and/or is accurate. Diagrams/Illustrations/ Pictures/Multimedia Diagrams, illustrations, pictures and multimedia are relevant, accurate and add to the reader’s understanding of the topic. All are referenced. Diagrams, illustrations, pictures and multimedia are relevant, accurate and add to the reader’s understanding of the topic. Most but not all are referenced. Diagrams, illustrations, pictures and multimedia are relevant, accurate. Some references are included. Diagrams and illustrations are not accurate or do not add to the reader’s understanding of the topic. Presentation: _________ / 10 Marks Category 4 3 2 1 Group Participation Equally divided amongst all members. Work is not divided equally amongst all members. Pacing Engaging rhythm and maximizes the allocated 5 minutes. Good rhythm and/or uses allocated 5 minutes efficiently. Poor rhythm and/or allocated time is not used efficiently. Poor rhythm and uses much less than or much more than 5 minutes. – consistency and quality Voice quality is clear and consistently audible throughout the presentation. Voice quality is clear and mostly audible. Occasionally speaks too fast or slow. Voice quality is clear and sometimes audible. Speaks too fast or too slow. Voice quality needs more attention and speaking pace affects engagement of presentation. Works Cited: _________ / 4 Marks A minimum of 3 citation of the source of information is included. This is separate from the citation required for the diagrams/illustrations/pictures/multimedia.
– businesses will not incur any other costs other than those identified by the analysis. Regulatory Burden The Australian Government has introduced the ‘Guide to Regulation’, which discusses the importance of cutting red tape. A key principle for Australian Government policy makers in the Guide to Regulation is that: The cost burden of new regulation must be fully offset by reductions in existing regulatory burden. All regulatory whether arising from new regulations or changes to existing regulation, must be quantified using the Regulatory Burden Measurement framework. The framework must also be used for quantifying offsetting regulatory savings, where applicable. As measured in accordance with the framework, the regulatory offset required to implement the option would be a total of $21.9 million. The Commonwealth’s share of this is $2.43 million. Governments of the States and Territories are not required under COAG policy to identify regulatory offsets. Some jurisdictions may have their own mechanisms regarding regulatory offsets, which would be a matter for those jurisdictions to consider. Sensitivity Analysis A sensitivity analysis has been conducted on the net present values by varying the parameters around the central analysis. These include: Discount rate: A discount rate of 3% and 11% will be assessed. Installation and maintenance costs: Installation and maintenance costs of tempering valves may vary particularly between States and Territories, where labour rates vary. Therefore a variation of ± 10% will be assessed. Percentage of “like-for-like” replacements: The percentage of “like-for-like” replacements was estimated in 2009 and may have changed. Therefore a variation of ± 10% will be assessed. 2 - Net Present Value Sensitivity Analysis Parameter Net Present Value Discount rate Low (3%) $256,109,865 High (11%) $190,551,059 Installation and maintenance cost Low (-5%) $208,111,335 High (+5%) $230,017,792 Percentage of “like-for-like” replacements
If Yes, please explain Education Education Name and Address of School Course of Study Years Completed Diploma/Degree High School Undergraduate College Graduate/ Professional Other (specify) Work Experience Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected status. Employer Dates Employed From To Work Performed Address ____________________________________ May we contact? Yes No Telephone Number(s) Hourly Rate/Salary Start Final Supervisor Reason for leaving Employer Dates Employed From To Work Performed Address ____________________________________ May we contact? _Yes _ No Telephone Number(s) Hourly Rate/Salary Start Final Supervisor Reason for leaving Employer Dates Employed From To Work Performed Address ____________________________________ May we contact? _ Yes _ No Telephone Number(s) Hourly Rate/Salary Final Supervisor Reason for leaving Employer Dates Employed From To Work Performed Address Telephone Number(s) Hourly Rate/Salary Start Final Supervisor