Pre-approval Form MINING MANAGEMENT Certificate Program

Pre-approval FormMINING MANAGEMENTCertificate Program Please read application instructions. Please print and complete the form.A NAMEMr Mrs Miss Ms . Dr. Other Ryerson Student NumberLegal SurnameOther/Previous SurnamesLegal First Name Legal Middle Name Third InitialB MAILING ADDRESS (notice of change is required in writing to the Enrollment Services and Student Records)Apt. Number StreetCity or Town Province Postal Code CountryHome( )E-mail AddressWork Phone( )Fax( )C EDUCATION (List all post-secondary education; include any project management training)Years Name and location of institution Degree ProgramtotototoOfficially certified transcripts of post-secondary results must be submitted (unless taken at Ryerson).Transcripts are enclosed from the following schools:Additional transcripts will be forwarded from the following schools:D EMPLOYMENT HISTORY (List all related work experience)Years Organization Title SupervisortotototototoAttach a detailed resume of work experience including at least 2 references with contact information that Ryerson cancontact to confirm your work experience. Ryerson will notify you if we are going to contact a reference.

Pre-approval FormMINING MANAGEMENTCertificate ProgramE DECLARATIONPlease not that your application will not be processed without the appropriate documentation.I have read and understood the application instructions, and my signature below indicates that all responses are true andaccurate. No relevant information, academic declaration, citizenship, status in Canada, or any other information, hasbeen withheld, otherwise my admission to or registration at Ryerson University may be revoked.Applicant Signature: ________________________________________________ Date: _______________________Note: This application will not be processed unless it is signed and dated.OFFICE USE ONLYApproval: _________________________________________________________ Date: _________________________Completed application form and all necessary documentation should be submitted to:Academic CoordinatorMining Management Certificate ProgramEmail: rosereid@ryerson.caThe G. Raymond Chang School of Continuing EducationRyerson University, 350 Victoria StreetToronto, ON M5B 2K3