Métis Student Solidarity Network Student ApplicAnt ... reach...Métis Student Solidarity Network...

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Métis Student Solidarity Network Student ApplicAnt - informAtion fAcilitAtor eligibility criteriA U i jÌà U Ài` >` >ÌÌi`} } ÃV ÜÌ Ìi «ÀÛVi v "Ì>À U }À>`ià £ä] ££ À £Ó U ÌiÀiÃÌi` i>À} >LÕÌ ««ÀÌÕÌià Vi}i À ÕÛiÀÃÌÞ U *ÀÛ`i > letter of support vÀ > Ìi>ViÀ] }Õ`>Vi VÕÃiÀ À jÌà VÕÌÞ VÕV iLiÀ° infinite reAch: mArch breAk cAmp FEBRUARY 10 TH , 2014 /i wÌi ,i>V >ÀV Ài> >« à `iÃ}i` Ì «ÀÛ`i jÌà } ÃV ÃÌÕ`iÌà ÜÌ > ÌÀ`ÕVÌ >` ViVÌ Ì Ìi jÌà >Ì ÜÌ "Ì>À° -ÌÕ`iÌÃ Ü i>À >LÕÌ jÌà ÃÌÀÞ >` VÕÌÕÀi° /i V>« ÃiiÃ Ì }>ÌiÀ jÌà } ÃV ÃÌÕ`iÌÃ Ü Ü>Ì Ì i>À Ài >LÕÌ Ìi ««ÀÌÕÌià >Û>>Li Ì Ìi «ÃÌÃiV`>ÀÞ i`ÕV>Ì° -ÌÕ`iÌà ÃiiVÌi` Ì >ÌÌi` Ìi V>« Ü Li «ÀÛ`i` ÜÌ vÀ>Ì Û>ÀÕà «À}À>à >` `ÃV«ià Vi}i >` ÕÛiÀÃÌÞ >` ÜV vÕÌÕÀi Là >Ài `i>`° -ÌÕ`iÌÃ Ü >à >Ûi Ìi ««ÀÌÕÌÞ Ì Ã«i> ÜÌ wÌi ,i>V >VÌ>ÌÀÃ Ü >Ài >ÌÌi`} «ÃÌÃiV`>ÀÞ ÃÌÌÕÌÃ Ü Ü Ã>Ài ÌiÀ iÝ«iÀiVið U *i>Ãi V> 1-613-798-1488 iÝÌ 137 or 1-800-263-4889 iÝÌ 137 pleASe forWArd ApplicAtion to U Ãi>}JiÌÃ>Ì°À} for ASSiStAnce ApplicAtion deAdline /à Þi>À Ìi >ÀV Ài> >« Ü Li i` >Ì Ìi >>`> V}V> iÌÀi >ÌÌ>Ü>] "° -iiVÌi` ÃÌÕ`iÌÃ Ü >Ûi ÌiÀ >VV`>Ì] i>à >` ÌÀ>Ûi VÛiÀi` LÞ Ìi "°

Transcript of Métis Student Solidarity Network Student ApplicAnt ... reach...Métis Student Solidarity Network...

Page 1: Métis Student Solidarity Network Student ApplicAnt ... reach...Métis Student Solidarity Network Section 1 – informAtion Source Ü ` ` Þ Õ i>À >L ÕÌ Ì i w Ìi ,i>V >ÀV Ài>

Métis Student Solidarity Network

Student ApplicAnt - informAtionfAcilitAtor eligibility criteriA

U� i��j��

U� �À���i`�>�`�>ÌÌi�`��}���}��ÃV�����Ü�Ì����Ì�i�«À�Û��Vi��v�"�Ì>À���

U� ���}À>`iÃ�£ä]�££��À�£Ó

U� ��ÌiÀiÃÌi`�����i>À���}�>L�ÕÌ��««�ÀÌÕ��Ì�iÃ����V���i}i��À�Õ��ÛiÀÃ�ÌÞ�

U� *À�Û�`i�>�letter of support�vÀ���>�Ìi>V�iÀ]�}Õ�`>�Vi�V�Õ�Ãi���À��À��jÌ�Ã�V���Õ��ÌÞ�V�Õ�V����i�LiÀ°

infinite reAch: mArch breAk cAmp

FEBRUARY 10TH, 2014

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>�`�V���iVÌ����Ì��Ì�i��jÌ�Ã� >Ì����Ü�Ì����"�Ì>À��°�-ÌÕ`i�ÌÃ�Ü�����i>À��>L�ÕÌ��jÌ�Ã���ÃÌ�ÀÞ�>�`�VÕ�ÌÕÀi°�/�i�V>�«�

Ãii�Ã�Ì��}>Ì�iÀ��jÌ�Ã���}��ÃV�����ÃÌÕ`i�ÌÃ�Ü���Ü>�Ì�Ì�� �i>À����Ài�>L�ÕÌ�Ì�i��««�ÀÌÕ��Ì�iÃ�>Û>��>L�i�Ì��Ì�i��

���«�ÃÌÃiV��`>ÀÞ�i`ÕV>Ì���°�-ÌÕ`i�ÌÃ�Ãi�iVÌi`�Ì��>ÌÌi�`�Ì�i�V>�«�Ü����Li�«À�Û�`i`�Ü�Ì����v�À�>Ì�������Û>À��ÕÃ�

«À�}À>�Ã�>�`�`�ÃV�«���iÃ����V���i}i�>�`�Õ��ÛiÀÃ�ÌÞ�>�`�Ü��V��vÕÌÕÀi���LÃ�>Ài����`i�>�`°�-ÌÕ`i�ÌÃ�Ü����>�Ã���>Ûi�Ì�i�

�««�ÀÌÕ��ÌÞ�Ì��ëi>��Ü�Ì����w��Ìi�,i>V���>V���Ì>Ì�ÀÃ�Ü���>Ài�>ÌÌi�`��}�«�ÃÌÃiV��`>ÀÞ���ÃÌ�ÌÕÌ���Ã�Ü���Ü����Ã�>Ài�

Ì�i�À�iÝ«iÀ�i�Við�

U� *�i>Ãi�V>��� 1-613-798-1488���iÝÌ�137�or�1-800-263-4889��iÝÌ�137

pleASe forWArd ApplicAtion toU� Ã�i��>}J�iÌ�Ã�>Ì���°�À}�

for ASSiStAnce

ApplicAtion deAdline

/��Ã� Þi>À� Ì�i��>ÀV�� Ài>��>�«�Ü���� Li� �i�`� >Ì� Ì�i�>�>`�>�� V���}�V>�� i�ÌÀi� ����>ÌÌ>Ü>]�" °� -i�iVÌi`�

ÃÌÕ`i�ÌÃ�Ü�����>Ûi�Ì�i�À�>VV����`>Ì���]��i>�Ã�>�`�ÌÀ>Ûi��V�ÛiÀi`�LÞ�Ì�i�� "°�

Page 2: Métis Student Solidarity Network Student ApplicAnt ... reach...Métis Student Solidarity Network Section 1 – informAtion Source Ü ` ` Þ Õ i>À >L ÕÌ Ì i w Ìi ,i>V >ÀV Ài>

pleASe forWArd ApplicAtion to: E-mail: [email protected] Fax: 1-613-722-4225

For assistance please call

1-613-798-1488 ext 137 or 1-800-263-4889 ext 137

Métis Student Solidarity Network

Section 1 – informAtion Source

��Ü�`�`�Þ�Õ��i>À��>L�ÕÌ�Ì�i���w��Ìi�,i>V���>ÀV��Ài>��>�«¶�

�F /i>V�iÀÉ�Õ�`>�Vi��Õ�Ãi���À�F *�ÃÌiÀ]�À�V�ÕÀi]���v�À�>Ì�����Õ�`i�F 7iLÃ�Ìi�F "Ì�iÀ

Student ApplicAnt - informAtion

Section 2 – perSonAl And contAct informAtion

Last name: Given name: Date of birth My Métis community: Gender:F�M F�F

Address During Academic Year (September – April)Street Address

City Province Postal Code Area Code & Telephone #

Permanent/Home Mailing Address (May – August) F Same as above

Street Address

City Province Postal Code Area Code & Telephone #

E-mail Address

Alternate E-mail Address

Page 3: Métis Student Solidarity Network Student ApplicAnt ... reach...Métis Student Solidarity Network Section 1 – informAtion Source Ü ` ` Þ Õ i>À >L ÕÌ Ì i w Ìi ,i>V >ÀV Ài>

PLEASE FORWARD APPLICATION TO:

E-mail: [email protected]

Fax: 1-613-722-4225

For assistance please call

1-613-798-1488 ext 137 or 1-800-263-4889 ext 137

Métis Student Solidarity Network

SECTION 3 – EDUCATION

STUDENT APPLICANT - INFORmATION

What is the name of the high school you

are currently attending?

What grade are you currently in? What do you want to study

in the future?

Please provide Letter of Support

Name of reference Position of reference Telephone # Email address

Has anyone in your family

attended college or

university before?

F Yes F No

If yes, have they attended

college or university?

F Yes F No

SECTION 4 – mOTIVATION

In no more than 300 words please explain how you believe the student you have chosen to support will Li�iwÌ�vÀ���>ÌÌi�`��}�Ì�i�Óä£{���w��Ìi�,i>V���>ÀV��Ài>��>�« in the space provided below:

Page 4: Métis Student Solidarity Network Student ApplicAnt ... reach...Métis Student Solidarity Network Section 1 – informAtion Source Ü ` ` Þ Õ i>À >L ÕÌ Ì i w Ìi ,i>V >ÀV Ài>

Métis Student Solidarity Network

Section 5 – letter of Support

Student ApplicAnt

Name

E-mail Address

Please identify yourself as one of the following:

�F /i>V�iÀ�

�F �jÌ�Ã����Õ��ÌÞ��Õ�V���

�F �Õ�`>�Vi��Õ�Ãi���À

��������Ài�Ì�>��xää�Ü�À`Ã]�«�i>Ãi�iÝ«�>���Ü�Þ�Þ�Õ�Ü�Õ�`����i�Ì��Li�Ãi�iVÌi`�>Ã�>�«>ÀÌ�V�«>�Ì�v�À�Ì�i�Óä£{���w��Ìi�,i>V���>ÀV��Ài>��>�«¶��

III-V>��>�`�i�>���Ì��[email protected]��À��>Ý�Ì��1-613-722-4225

________________________ ______________Signature of Parent/Guardian Date

Page 5: Métis Student Solidarity Network Student ApplicAnt ... reach...Métis Student Solidarity Network Section 1 – informAtion Source Ü ` ` Þ Õ i>À >L ÕÌ Ì i w Ìi ,i>V >ÀV Ài>

Métis Student Solidarity Network

informAtion

AlternAte emergency contAct:

emergency contAct:

medicAl

heAlth informAtion

2014 March Break caMp - medicAl form

School: Grade:

Name:

Home A`dress:

Name: Relationship: Telephone:

Name: Relationship: Telephone:

Health Card Number:

Doctor’s Name : Doctor’s Phone Number:

Under a doctor’s care at present?: F�Yes F�No

If yes, please provide details and note any precautions to be taken:

Will any medications be taken during the program?: F�Yes F�No

If Yes, please specify the name of the medication, dosage and frequency:

Please list any allergies (food, environmental, medication): List any special dietary considerations (vegetarian, religious):

Please indicate whether full participation in activities (outdoors and indoors) is allowed: F�Yes F�No

�v���]�Ü�>Ì���`�wV>Ì���Ã�Ü����Li��iViÃÃ>ÀÞ¶��

________________________ ______________Signature of Parent/Guardian Date

Page 6: Métis Student Solidarity Network Student ApplicAnt ... reach...Métis Student Solidarity Network Section 1 – informAtion Source Ü ` ` Þ Õ i>À >L ÕÌ Ì i w Ìi ,i>V >ÀV Ài>

pleASe forWArd ApplicAtion to: E-mail: [email protected] Fax: 1-613-722-4225

For assistance please call

1-613-798-1488 ext 137 or 1-800-263-4889 ext 137

Métis Student Solidarity Network

mArch breAk cAmp (mArch 8-12, 2014)

pArentAl conSent form

________________________ ______________Signature of Parent/Guardian Date

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Métis Student Solidarity Network