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Student Application Form

The application deadline is: Monday, May 13, 2024 (11:59 pm ET).

A member of the project team will contact you if your application is chosen for participation.

First Name: *

Last Name: *

Pronouns:

Do you self-identify as a member from an equity-deserving community? Note: The term “equity-deserving communities” refers to communities that experience significant collective biases and barriers to participating in society - including attitudinal, historic, social and environmental barriers based on race, ethnicity, disability, gender identity, sex, sexual orientation and other aspects of identity. Please indicate, either YES or NO below *

Yes

Email Address: *

Phone number: *

Age: *

Grade: *

Grade 9

Grade 10

Grade 11

Grade 12

Name of high school: *

City *

Province/Territory: *

Alberta

British Columbia

Manitoba

New Brunswick

Newfoundland and Labrador

Northwest Territories

Nova Scotia

Nunavut

Ontario

Prince Edward Island

Quebec

Saskatchewan

Yukon

Full name of parent/guardian: *

Phone number of parent/guardian: *

Email of parent/guardian: *

Please download this release form (https://ceric.ca/wp-content/uploads/2024/04/CERIC_Participation_Release_Form.pdf) and have your parent/guardian sign it. Then, upload the completed release form here.

Do you require community hours? *

Yes

Student Application Form

Click Submit to finish.

This form was created by CERIC Google Forms

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