PASS Peer Facilitator Application Form: 2016 team recruitment

Family Name

First Name

Telephone (Mobile)

Preferred Name

Telephone (Alternative)

Gender
Female / Male
USyd Email Address:

Citizenship

Visa number and expiry
(For international students)

Date of birth (DD/MM/YY)

Unikey

Course (E.g., B.Ec):

Student ID (SID)

What was the first semester and year of enrolment into your current degree?
S1  or S2 
Expected MONTH and YEAR of degree completion
Month:
Year:

Year:

Semester Postal Address

Permanent Postal Address
(If different to your semester postal address—we need this to send any training materials to you during the Summer break, should you be successful)

Please indicate which units you would like to apply for and the year you completed the unit/will complete: Rather than ticking boxes, please write “1, 2, 3 …” in the boxes in the order or your preferred units to work in.
ACCT1006

Year:
Lecturer:
ACCT5001

Year:
Lecturer:
ACCT2012

Year:
Lecturer:
ACCT6001

Year:
Lecturer:
BUSS1001

Year:
Lecturer:
ACCT6010

Year:
Lecturer:
BUSS1002

Year:
Lecturer:
BUSS5000

Year:
Lecturer:
BUSS1020

Year:
Lecturer:
BUSS5001

Year:
Lecturer:
BUSS1030

Year:
Lecturer:
BUSS5002

Year:
Lecturer:
CLAW1001

Year:
Lecturer:
CLAW5001

Year:
Lecturer:
INFS1000

Year:
Lecturer:
FINC5001

Year:
Lecturer:
FINC2011

Year:
Lecturer:
QBUS5001

Year:
Lecturer:
FINC2012

Year:
Lecturer:

1. I have achieved a “Distinction” or “High Distinction” grade in the Unit(s) of Study I am applying to facilitate in and a “Credit” grade average overall
Yes  No 
2. I can attend the 3 days of training (February 16th, 17th, 18th, 2016)
(attendance is compulsory if you are to be considered for a PASS Facilitator role)
Yes  No 
3. I can commit to working for the full year
Yes  No 
4. I have attended PASS sessions
Never


1-4 times


5 or more time 

If you have attended PASS sessions, list approximately how many sessions you have actually attended in each unit of study:

7. I have applied for the: Please tick 

1. 2015/2016 Summer Industry Placement Program 
2. 2016, Semester 1 Industry Placement Program 
3. Washington DC Placement 
4. L.A. Placement 
5. China Placement 
6. None of the above