Building the Fire, Walking with Medicine Program: Application form

Current Applicant Information
Address
School Information
Parent/Guardian Information
Program Qualification
Additional Information
Complete

APPLICANT INFORMATION

First Name*

Last Name*

Preferred Name*

Date of Birth*

Email Address*

Phone Number*

Alternate phone number

Select the gender identity(ies) that best fit you:*

The options identified below are based on the terminology used by the Ontario Human Rights Commission in the Policy on Discrimination and Harassment Because of Sexual Orientation and the Policy of Preventing Discrimination Because of Gender Identity and Gender Expression. [2] Trans refers to a person who identifies with a gender other than the one assigned to them at birth, or to a person whose gender identity and gender expression defers from stereotypical masculine and feminine norms. It is also used as an umbrella term for those who identify as transgender, transsexual, trans, gender variant, gender non-conforming, genderqueer, or an analogous term.

Female

Male

Trans [2]

Two-Spirited

Another Gender

Yes, I would like to self-identify as Indigenous for the purpose of this program.