Uni 101/102 Application Form - 2024/2025

University 101/102 is a course for people who have experienced significant barriers to university.

We really want the application process to be as accessible as possible, so if you have any questions at all or if there is something we can do to make this easier for you, please contact us!

PHONE: 250-721-6516

EMAIL: uni101@uvic.ca

Confidentiality: The information provided on this application form is kept entirely confidential and is used only by the University 101/102 Applications Committee to assess applicant eligibility. Information provided on the University 101/102 application form is never given to outside individuals or organizations. Survey questions and responses will be stored only in Canada.

Part 1: Who are you and how can we stay in touch?

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* 1. Contact info

Preferred Name

Legal name (for UVic registration)

Address

City

Postal Code

Gender (for UVic registration)

Email Address

Phone Number

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* 2. Date of birth (for UVic registration)

Date of birth (DD/MM/YYYY)

Date

Part 2: What resources do you have? What support might you need?

NOTE: Transportation, childcare costs, laptops and internet/wifi will be subsidized by the program as needed/available. Information about support is for program planning, not to assess eligibility.

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* 3. Please mark your approximate annual income on the line

less than 10,000

20,000

more than 30,000

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 4. Do you support anyone (besides yourself) on this income?

Yes. How many other people?

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* 5. This is a hybrid course. Will you be attending ONLINE or IN PERSON?

Online

In person

Not sure

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* 6. For the IN-PERSON portion of class:

	Yes	No	Not sure	Planning to attend online
Will you need bus tickets to get to/from class?	Will you need bus tickets to get to/from class? Yes	Will you need bus tickets to get to/from class? No	Will you need bus tickets to get to/from class? Not sure	Will you need bus tickets to get to/from class? Planning to attend online
Will you need a parking code to park on class nights?	Will you need a parking code to park on class nights? Yes	Will you need a parking code to park on class nights? No	Will you need a parking code to park on class nights? Not sure	Will you need a parking code to park on class nights? Planning to attend online

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* 7. For the ONLINE portion of class:

	Yes	No	Sometimes	Planning to attend in person
Do you have a laptop or tablet?	Do you have a laptop or tablet? Yes	Do you have a laptop or tablet? No	Do you have a laptop or tablet? Sometimes	Do you have a laptop or tablet? Planning to attend in person
Do you have access to internet/wifi?	Do you have access to internet/wifi? Yes	Do you have access to internet/wifi? No	Do you have access to internet/wifi? Sometimes	Do you have access to internet/wifi? Planning to attend in person

If SOMETIMES, please elaborate

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* 8. Will you require childcare?

Yes. How many children and what ages?

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* 9. What other support might you need? i.e. Large print readings, audio recordings, etc.

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* 10. Do you have any dietary restrictions?

Gluten-free

Vegetarian

Vegan

Other

None of the above

Other (please specify)

Part 3: What are your experiences with education?

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* 11. Please tell us why you would like to take this course.

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* 12. What are your specific learning interests?

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* 13. Tell us a little about your past experiences of school, such as high school, college or other courses or programs. When did you last go to school, either full time or for a course? What was school like for you?

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* 14. Are you now, or will you be, taking any courses or programs in the coming year (besides University 101 or 102)? If yes, what course or program?

Yes

If yes, what course or program?

Part 4: What barriers are in your way?

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* 15. What has/would get in the way of you accessing college or university? What would make that challenging? Please reflect on any barriers that are relevant to you, and share how they impact you. Barriers might include things like: health, mental health, stigma and marginalization, financial barriers, social barriers.

Health (mental and/or physical)

Stigma and Marginalization (for example, facing bias because of poverty, disability, or racism.)

Financial barriers

Social barriers (for example, caring for relatives full-time, pressures not to attend school or to work in a certain field, a lack of supportive people, etc.)

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* 16. Other barriers or personal circumstances you want us to know about:

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* 17. What is the impact of these barriers on your life? What would it be like if they were not present?

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* 18. Have you had experiences of trauma that still affect you today?

Yes

Not sure

Part 5: Some final (but important) questions

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* 19. Students are asked to create and commit to a community agreement which requires that they act in a respectful manner and refrain from hateful, prejudicial and aggressive behaviour in class. If your application is selected would you be prepared to create and honour such a document?

Yes

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* 20. If your application is selected, would you make a commitment to attend class every Tuesday and Thursday afternoon from 5:00 pm to 8:30 pm for the duration of the course (late September to early April)?

Yes

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* 21. Which information session did you attend?

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* 22. How did you hear about Uni 101?

Part 6: Reference

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* 23. Since attendance, participation and group dynamics are key aspects of this course, please provide the name and contact information for someone (other than a family member) who has known you for at least a few months. Ideally this would be someone who could tell us about your participation and attendance in a group setting. If you are new to Victoria, or are otherwise unable to provide a reference, please contact us to make other arrangements.
Note: By filling out the reference contact information below, applicants agree to have University 101/102 Program Staff or Volunteers contact the person named as reference to discuss potential eligibility for the University 101 course.

Reference Name

Relationship to you

Best time to contact

Email Address

Phone Number

Thank you for taking the time to fill out this application!
We look forward to being in touch with you soon.

For more information about our Application Process, please go to our website.