Cochlear Autumn School of Engineering

Gateway to Engineering10–13 April 2017

OnlineForms are available on the CASE pages of the Engineers Australia, Sydney website: www.engineersaustralia.org.au/sydney.

MailThe application form is attached for your completion. Photocopied forms are acceptable.

RequirementsSections A, B, C & D are to be completed by the applicant.

Section E is to be completed by a Rotary Club if applicable. Please note that applications can be made through your local Rotary Club or direct to Engineers Australia, Sydney.

If you have any problems contacting your local Rotary Club, contact Rotary International South Pacific & Philippines Office on 02 9635 3537.

All applications must have your most recent school report attached. If your report is not attached your application will not be considered.

Closing DateApplications are open from 1 February 2017 and are accepted on a first come, first served basis. Please register early to avoid disappointment.

NotificationSuccessful applicants will be notified as soon as practicable after receipt of the application. Applicants are welcome to phone for an update of the progress of their application at any time.

The letter of acceptance will request full payment by Friday, 10 March 2017. More specific details on activities, what to bring, start and finish times for each day will be indicated in later correspondence.

WelcomeThe Cochlear Autumn School of Engineering (CASE) 2017 will take place from Monday, 10 April to Thursday, 13 April 2017.

CASE is an initiative organised by Engineers Australia, Sydney, ‘Engineering’ Universities and participating Rotary Clubs. The objective of CASE is to give Sydney metropolitan area high school students a better understanding of what engineering is and how it works in everyday life.

CASE will bring together 50 Year 11 and 12 Students from the Sydney Metropolitan Area and who are facing choices which will influence their future careers.

Engineers cultivate creative, enquiring minds, a strong interest in mathematics, science and the environment, and want to contribute to improving the quality of life for everyone. Within each engineering discipline there are many career paths from management to research and teaching, from construction and maintenance to sales and marketing.

Engineering is a prestigious profession and is essential for a nation’s future development, creating wealth and employment which increases living standards throughout our societies.

Throughout the program the students will meet and interact with professional engineers employed by government, private companies, researchers and academics in a wide range of engineering disciplines. The students will attend lectures/demonstrations at participating NSW universities, and participate in industrial visits, providing students with the opportunity to see the different engineering disciplines at work.

Rotary SupportRotary Clubs, with their continuing interest in the youth of Australia, provide invaluable assistance in selecting students to participate in CASE. Rotary will be assisted by school principals and teachers in the student selection process. Applications do not have to be made through Rotary.

ProgramCASE will convene at 8:30am on the morning of Monday, 10 April at Engineers Australia, Harricks Auditorium, Ground Floor, 8 Thomas Street Chatswood. Departure each day will be at approximately 5.00pm.

Students will be required to make their own travel arrangements to and from Harricks Auditorium each day. The Cochlear Autumn School will end on Thursday, 13 April.

RulesThere will be a strict ban on drugs, alcohol and smoking from all students participating.

CostThe cost to attend CASE is $250.00. It covers all meals throughout the day and transport while attending CASE. Travel expenses to the Engineers Australia, Sydney office and return each day are the responsibility of the student.

ABOUT THE PROGRAM

HOW TO APPLY

If you have any questions in completing the application form, please contact:

Katrina Meggitt – Events Manager

Engineers Australia, Sydney, Level 3, 8 Thomas Street, Chatswood NSW 2067

Phone: 02 9410 5613 | Fax: 02 9410 0000 | E-mail: nswregistration@engineersaustralia.org.au

Applicants must be in Year 11 or 12 in a High School in 2017. Sections A, B, C, & D must be completed by the applicant. Section D must also be signed by the applicant’s parent/guardian. Section E should be left blank; it is to be completed by your local Rotary Club if applicable. Your application can be made through your local Rotary Club and District or direct with Engineers Australia, Sydney. If you require information on your District, contact Rotary International South Pacific & Philippines office: (02) 9635 3537.

NOTE: All applications must have your most recent school report attached. If your report is not attached your application will not be considered.

Photocopied forms are acceptable. This form is also available for downloading on the CASE pages of the Engineers Australia, Sydney website: www.engineersaustralia.org.au/sydney

Section AFamily Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . First Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Male/Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D.O.B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Address (home) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . State . . . . . . . . . Postcode . . . . . . . . . . .

Home Phone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Student Mobile Phone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

E-mail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Name of School . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Address of School . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Name of Science/ Industrial Arts Teacher (if applicable) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Section BWrite, in about 50 words, why you would like to attend CASE?

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Section CIndicate two areas of study you would prefer to follow at CASE by numbering the areas (1 being the preferred) you are most interested in:

Biomedical Civil Computer Chemical Electrical

Mechanical Environmental Mining Aeronautical Mechatronic

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Application Form

COCHLEAR AUTUMN SCHOOL OF ENGINEERING

Gateway to Engineering 10–13 APRIL 2017

Section DDeclaration of participant:

I, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . the applicant, understand that I will be required to adhere to the instructions of the CASE management and staff during my participation in the program. In particular, I agree to the rules of the CASE management: no smoking, no alcohol, no drugs. I understand that should I fail to keep to these rules, I may be returned home by the first available transport, with any additional costs incurred being payable by my parent/guardian. I agree to the information in Section A & B, with the exception of personal address details, being used in press releases promoting CASE.

Signature of applicant . . . . . . . . . . . . . . . . . . . . . . . . Date: / /

Declaration of parent/guardian:

I, the parent/guardian of the above applicant, approve of the participation of my son/daughter in CASE in Sydney April 2016, and as required, agree to pay $270.00 (incl. GST) being the cost of attendance at CASE, plus additional costs which may be incurred. I understand that my son/daughter will be required to adhere to the instructions and rules of the CASE management and staff and that none of the aforementioned parties may be held responsible for accidental injury, sickness,or the consequences there of during my son’s/daughter’s participation in the CASE program. I further authorise the CASE management and staff to consent (where it is impractical to communicate with me) to my son/daughter receiving urgent medical or surgical treatment as may be deemed necessary and I will meet such cost which may be incurred with this treatment.

Name of parent/guardian (please print) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Relationship . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Signature of parent/guardian . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Date: / /

Business phone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Home phone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Mobile . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Section ETo be completed by Rotary Club (if applicable).

Submitted by Rotary Club of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Name (please print) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Signed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Phone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Student will be financially assisted by Rotary to attend CASE Yes No

Engineers Australia Autumn School is proudly sponsored by Cochlear

Cochlear is the global leader in implantable hearing solutions. Around the world, Cochlear helps hundreds of thousands of customers to connect to family, friends and the world of sound. Cochlear is recognised in industry as an innovative company and a unique employer. In 2014 Cochlear was recognised as one of the Top 10 Most Respected Companies in Australia. For information on Cochlear, go to www.cochlear.com.