Aboriginal Youth Ambassador Application Form - Due Wed. June 28/17 at 12 noon
1.
First name:
 

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2.

Last Name:  

 

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3.

Email Address:  

 

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4.
Phone Number: 
 

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5.
Address: 
 

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6.
Please indicate the best way for us to contact you: 
 

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7.
Date of birth (yy/mm/dd):
 

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8.
Do you have any transportation concerns we should be aware of? 
 

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9.
Are you able to attend the full length of the program? If not, please specify.  
 

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10.
Are there any barriers that might prevent you from participating in this program? 
 

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11.
Please list two reasons why you would like to participate in the Kenjgewin Teg Ambassador Program? 
 

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12.
What are you hoping to gain from participating in this program? 
 

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13.
Please list any additional information you would like to share and any special considerations that organizers may require. 
 

350 characters left.