Youth Civic Engagement Lab 

2-DAY TRAINING-WORKSHOP APPLICATION FORM

Venue: The training-workshop will be held in Arnprior, ON, the exact venue will be announced to the selected trainees       
Duration: Nov. 10,2023 - departure from Ottawa;  Nov. 11-12, 2023 - training; Nov. 12,2023 - return to Ottawa.
Application Due Date: Sunday Nov 5, 2023

*For applicants below 18 years of age: The organizers will ask your parent/legal guardian's consent after you complete and submit your application. 


Email *
I. PERSONAL INFORMATION  
1. Given Name/s:  *
2. Surname: *
3. Email Address: *
4. Are you between 15 and 30 years of age until 31 December 2023?  *
5. Are you:
 *
6. Mobile number:
 *
7.Home phone number (if any):
8.Residential address:

Please include street number, street name, city, province and postal code
 *
9.Language Perference: *
10.Highest level of academic credential/s you have attained as of the date of this application:
*
11.Are you a student who is enrolled in any Canadian educational institution? If yes, 
please provide the name of school/s and program/major
12.Do you have an occupation? if yes,  please provide your work position; name and address of employer:
Clear selection

13.Emergency contact person in Canada:

*

14.Relationship with the emergency contact person:

*

15.Contact number of emergency contact person:

*

16.Email address of emergency contact person:

*
II. SHORT ESSAY
17. WHY DO YOU WANT TO PARTICIPATE IN THE FCYCEL TRAINING-WORKSHOP? (please limit your answer to a maximum of five sentences. Also indicate if one of your motivations is to earn school credits.)
 *
III. DECLARATIONS
18. Do you consider yourself as a member of any Indigenous group in Canada? 

*Indigenous group refers to whether the person is First Nations (North American Indian), Métis and/or Inuk (Inuit). A person may be included in more than one of these three specific groups. Aboriginal peoples of Canada (referred to here as Indigenous peoples) are defined in the Constitution Act, 1982, Section 35 (2) as including Indian, Inuit and Métis peoples. First Nations (North American Indian) includes Status and non-Status Indian. 

Clear selection
19. If your answer is which group do you belong to?
 *
20.Do you consider yourself as a visible minority in Canada?

*Visible minority refers to persons, other than Aboriginal peoples, who are non-Caucasian in race or non-white in colour.

 *
21.If your answer is YES, which minority group do you belong to?
Clear selection
22.Do you consider yourself as a person with a disability?

*The Government of Canada does not have a single, official definition of disability- instead, it advises consultation with the definitions of disability used by the World Health Organization (WHO) and by the United Nations (UN) in its Convention on the Rights of Persons with Disabilities.The UN Convention on the Rights of Persons with Disabilities describes persons with disabilities as those who have long-term physical, mental, intellectual or sensory impairments which in interaction with various barriers may hinder their full and effective participation in society on an equal basis with others.

 *
23.Which gender do you identify?:
*

24.If you selected 2SLGBTQI+, please check the box next to the description that applies to you: 


25.Are you a newcomer in Canada? * A newcomer is a person who left another country to settle in Canada within the last 5 years.
*
26.Do you consider yourself as belonging to an official language minority in Canada? *In Canada, official language minorities (OLMs) are English-language communities in Quebec and French-language communities outside Quebec
 *
27.Which description applies to you?
Clear selection
28.Have you volunteered in any organization in Canada?
 *
29.If yes, in what city/municipality is this organization located?
30.How did you come to know about the FCYCEL program? 
Clear selection
31.Please specify other means you obtained the FCYCEL program information: 
By affixing my e-signature or writing my full name below, I certify that the information provided in this application is accurate and complete to the best of my knowledge. I understand that any false statements or omissions may result in the rejection of my application.  *
Date: (mm/dd/yyyy)
 *
For applicants below 18 years of age: Name of parent/legal guardian and email address of parent/legal guardian   *
V. PERSONAL INFORMATION CONSENT AND DISCLOSURE STATEMENT

By providing your personal information to us, you are giving your consent for the Philippine Centre Canada (PCC) to collect, retain, use, and disclose your personal information in accordance with the terms outlined below:

Purposes of PCC’s use , collection and retention of personal information

a. Processing and evaluation of training applications b. Organizing and conduct of the training-workshop for civic engagement and project proposal making; c. Pre-identification of potential project proponents and recipients of microgrants;  d. Archive of program records;  e. To fulfill the information collection, sharing and reporting duties of the PCC to the Canada Service Corps (CSC), including the input and transmission of personal information of training participants and microgrant recipients in CSC’s Participant Contact Information Reporting Instruction and Organization Data Input Window.; and,  f. To communicate with you regarding FCYCEL program- related activities, future PCC programs;  or to reach your emergency contact person, in cases of emergency during any FCYCEL program activity where you may be present. 

Purposes of disclosure to CSC, and use of disclosed personal information 

Disclosure of your personal information that can be found in this application form will only be made to the CSC, consistent with item (e) above, and it will be used by CSC in its future reporting, validation , survey of participants, and evaluation of the FCYCEL program. 

Consent

By accomplishing this application form, signing below, and submitting this form to PCC, you consent to the collection, retention, use, and disclosure of the personal information as described in this statement. Likewise, you acknowledge that you have read and understood this statement. You have the right to fully or partially withdraw your consent to the collection, retention, use and disclosure of your personal information at any time by contacting melanie.radovan@pcc-ottawa.ca .

Security

We take reasonable measures to protect your personal information from unauthorized access, disclosure, or alteration. However, please be aware that no data transmission over the internet or storage system can be guaranteed to be 100% secure.

Access and Correction

You have the right to access and correct your personal information held by us. To do so, please contact melanie.radovan@pcc-ottawa.ca .

Questions

If you have any questions or concerns regarding the collection, use, or disclosure of your personal information or if you wish to withdraw your consent, please contact melanie.radovan@pcc-ottawa.ca 

By affixing my e-signature or writing my full name below, I acknowledge that I understand the terms of this Statement, and that I am granting my full and voluntary consent to the collection, retention, use and disclosure of my personal information in the manner described therein. 

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Date: (mm/dd/yyyy)  
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