Youth Forums Selection Process

Youth participants (aged 14-18) interested in attending the Leadership Forum on Diversity and Inclusion have until April 30^th to follow a two-step process:

1. – Complete the below Registration Form
2. – Complete the submission process that includes uploading a personal bio and answering the question “What are the barriers to and benefits of true diversity and inclusion in your community?” (your answer can be delivered in any format: a written piece, an artwork, a video of a performance)

A registration fee of $300 will be payable by all youth selected. (For anyone for whom this may be a barrier, you may apply for a bursary from Experiences Canada’s special measures fund.)

A team of volunteer judges will assist Experiences Canada in reviewing all submissions over the first two weeks of May.  The final selection will be determined based on three factors:

1. – The quality of your submission
2. – Your personal bio and interest in issues of diversity and inclusion
3. – Ensuring a representative balance of Canada’s geographic, cultural, and linguistic diversity

Our goal will be to notify all participants of our decisions by May 17^th, 2019.

We thank all that apply for their interest in our program, and wish you good luck with your application!

Register

Register

If you are human, leave this field blank.

First Name *

Last Name *

Email Address *

Password *

Eight characters minimum One lowercase letter One uppercase letter One number One special character

Phone Number *

Example: 9999999999

Text Contact (Cell Phone)

Example: 9999999999

Address *

City *

Province * Alberta British Columbia Prince Edward Island Manitoba Northwest Territories New Brunswick Nova Scotia Nunavut Ontario Quebec Saskatchewan Newfoundland and Labrador Yukon

Postal Code *

Example: A1A 1A1

Birth Date *

Have you ever participated in an Experiences Canada exchange or forum?

Yes, What YearYes, What Year

No

What language do you want to correspond with us? *

English

French

Name of School You Are Currently Attending

Name of teacher (if being submitted as part of a class/team project or assignment). Name of youth leader (if being submitted as a part of Duke of Edinburgh/Girl Guides/other youth group activity)

We encourage the participation of youth who have traditionally been under-represented in exchanges. Please indicate if you fall within the following groupings:

1. Youth with Special Needs and/or Disabilities?

Yes

No

A person with a long-term physical condition, mental condition, or health problem, who is limited with respect to functions in the home, in school or other activities (e.g. leisure time activities)

2. Youth from low-income households?

Yes

No

A person who lives in a household earning less than the Low Income Cutoff as defined by Statistics Canada.

3. Visible minority youth?

Yes

No

An individual, other than an Aboriginal person, who is non-Caucasian in race or non-white in colour.

4. Indigenous youth?

Yes

No

A member of a First Nation, a Métis or an Inuit.

5. Youth from rural or isolated areas?

Yes

No

A person who lives in a community with a population less than 10,000

Travel & Other Preferences

What is the nearest major airport to your community?

What distance (in km) are you from this major airport?

Special Travel or Dietary Requirements?

What is your Tee Shirt Size? * XS S M L XL XXL

Adult sizes

How did you hear about Experiences Canada Youth Leadership Forums?

Questionnaire

1. My Attachment to Canada is:

Strong

Moderate

Minor

I don't know

2. My knowledge about Canada's diverse history & culture is:

Strong

Moderate

Minor

I don't know

3. My community involvement is:

Strong

Moderate

Minor

I don't know

Communications Options

Users must click YES or NO to the following communications preferences:

Sign Me Up For The Experiences Canada Youth Leadership Forums E-blast?

Yes

No

Send An Email To My Teacher/Group-Leader When I Complete My Submission

Yes

No

Email Address of Teacher/Group Leader

Collection and Use of Personal Information

As the parent/guardian, I hereby give my consent for EXPERIENCES CANADA to collect the personal information required for submission to the EXPERIENCES CANADA Youth Leadership Forums. I understand that this personal information is required for the purposes of selection and program delivery and that it will only be used by EXPERIENCES CANADA or disclosed to select third parties who are acting as suppliers, service providers or who provide funds to EXPERIENCES CANADA and who have agreed to protect the personal information supplied by EXPERIENCES CANADA.

By checking “Yes” I indicate that I freely give my consent to the collection and use of personal information of this participant as set out above. *

Yes

I understand that my child (or myself) may have the opportunity to express himself/herself verbally or in written form, create or appear in photographs and/or video recordings at any point during the EXPERIENCES CANADA Youth Leadership Forum, individually or as part of the group.

Please choose either YES or NO *

Yes, I hereby give EXPERIENCES CANADA, its funders and associated partners, permission to release and/or publish these statements, photographs and/or video recordings for educational and promotional purposes.

No, I do not give EXPERIENCES CANADA, its funders and associated partners, permission to release and/or publish these statements, photographs and/or video recordings for educational and promotional purposes.

Name of participant *

Name of parent/guardian

If under age of majority

Date (today) *

Daytime Phone Number

Example: 9999999999

Email Address of signatory