WISPC CONFERENCE APPLICATION
The Seneca Nation will be sending a Young Adult Cohort of 6 to this year's World Indigenous Suicide Prevention Conference located in New Zealand. Interested young adults are encouraged to apply and agree to the following commitments:
Applicant Information
Please provide the most accurate details to support your application
Full Legal Name
*
First Name
Last Name
Ögwe’öwe:ka’ Name
Clan
*
Date of Birth
*
Seneca Nation Territory residing/ties with
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Seneca Enrollment #
*
Gender Identification
*
Female
Male
Two-Spirit
Nonbinary
Prefer not to say
Self-Describe
This is a fill in the
blanks
field. Please add appropriate
blank
fields and text.
Pronouns
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Emergency Contacts
Please provide the most accurate info
Primary Emergency Contact
*
First Name
Last Name
Relationship to Applicant
*
Primary Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Secondary Emergency Contact
*
First Name
Last Name
Relationship to Applicant
*
Secondary Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
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Travel Information
Please help up understand your current details of this portion. We will provide the steps to acquire any missing requirements.
Do you have a valid passport?
*
Yes
No
I am willing to obtain one immediately
If yes to previous question, provide Passport #
Have you ever been convicted of an offense?
*
Please Select
Yes
No
Prefer not to say
If yes, please contact staff privately about situation
Dietary Needs
*
Please include any necessary information about your diet practices . Type N/A if none.
Accessibility or Accommodation Needs
*
Type N/A if none.
Medical Information
*
Please provide necessary info (ALLERGIES, MEDICATIONS, CONDITIONS). Type N/A if none.
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Passport Expiration Date
Program Question
This portion is very important for you to help staff learn more about you. Please provide the best answers that represent you best.
1) Why do you want to participate in the 18-24 years WISPC Young Adult Cohort?
*
2) Describe a time your demonstrated leadership or carried on important responsibilities.
*
3) How do you manage stress, conflict, or difficult situations?
*
4) What does being a young Seneca adult mean to you?
*
5) What conference or youth events have you ever attended?
*
6) Have you ever traveled internationally?
*
Yes
No
7) How would you share the knowledge obtained from this experience with the community?
*
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REQUIRED Documentation still needed to support your application!
Will provide list of these documents at the first Info Night! Lauren Huff will be available to collect when available to you. Please contact with any questions in the meantime! L.Huff@sni.org
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