Participant Information / Application Form
What program are you applying for?
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March Break Design Camp - Tyendinaga
Name:
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First Name
Last Name
Select the pronouns you use:
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She/Her/Hers
He/Him/His
They/Them/Theirs
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Not Listed / Other
Address:
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Telephone:
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Email Address:
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example@example.com
What is your preferred method of communication?
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Phone Call
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Text Message
All of the Above
Date of Birth:
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Month
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Day
Year
Date
Do you have a Social Insurance Number?
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Yes
No
Do you have an active bank account?
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Yes
No
Community Membership:
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Status First Nation / Registered On-Reserve
Status First Nation / Registered Off-Reserve
Non-Status
Metis
Inuit
If you are a member of a First Nation, which First Nation you are a member of?
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Education and Employment Status
Are you currently Employed?
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Yes, full-time
Yes, part-time
Yes, self-employed
No
Are you currently a student?
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Yes
No
If you answered yes to the above question where and what are you studying?
What is your highest level of education?
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Elementary School
High School
College Diploma
University Degree
Post-graduate Degree
Trade Certification
Other
Do you identify as someone with a disability (physical, mental, learning)?
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Yes
No
Please let us know below if there is anything we can do to better support you through the program.
What are you hoping to gain from this program?
Person to notify in case of emergency:
Name (first and last):
Relationship:
Telephone:
Email
example@example.com
Date:
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Month
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Day
Year
Date
Signature:
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