IWC Application Form
[Indigenous Women+ Council]
Thank you for your interest in joining the PAFNW+'s first-ever provincial Indigenous Women+ Council!
Our goal is to develop the voices of Indigenous Women+ in the workplace, address Gender-Based Violence, and to prevent Murdered and Missing people. Please fill out this form to tell us about yourself and why you are interested in joining the IWC.
Name
*
First Name
Last Name
What are your pronouns/Gender identity? (Please note: we ask this question to ensure that we are being inclusive to LGBTQQIA2S+ as this community is impacted the most by Intimate Partner Violence according to a study done in 2018 by Statistics Canada [source: https://www.statcan.gc.ca/en/topics-start/gender_diversity_and_inclusion?HPA=1])
*
Are you 16 years of age or older?
*
Yes
No
What B.C. city do you live in?
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Do you have any disabilities and accommodations that you might need for Zoom and/or in-person meetings? i.e. Anxiety - Support person, CPTSD - Time away, Deafness - Speech Translator, Wheelchair - Wheelchair accessible facilities, etc.
*
Email
*
example@example.com
Phone Number
Please enter a valid phone number.
Do you identify with any of the following?
*
First Nations
Metis
Inuit
No
Other
Please enter your nation(s).
Are there any particular workshops or professional development opportunities you would like to see included in this program?
*
What skills would you like to share with the council?
*
Please tell us about any experience or interest you have relevant to workplace voice development (others' or your own), gender-based violence work, and prevention of Murdered and Missing Indigenous People.
*
Submit
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