Social Changemakers Registration

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Thank you for your interest in attending the Social Changemakers Leadership Conference taking place March 4-5, 2022, with approximately two hours of virtual program per day. This program is for high-school youth aged 14-19.

Harmony Movement is committed to providing content that is accessible to the widest possible audience, regardless of technology or ability. If there are any issues in completing the application form please contact info@harmony.ca or 647-746-0440.

Please note that the personal contact information you provide below will only be used for contacting you regarding the Leadership Series. It will not be shared beyond Harmony Movement. Emails will come from info@harmony.ca.

First and last name: *

Email: *

Name of School: *

Mailing Address

Participants will receive a Welcome Kit with goodies and t-shirt prior to the conference taking place. The mailing address will only be used for sending this kit, so please provide the address that you will be at for the next month.

City & Province/Territory: *

Postal Code:

T-Shirt size:

Small

XXL

Clear selection

Do you identify as any of the following? (Check all that apply)

Living in a rural setting

Living in an urban setting

First Nations, Metis or Inuit

Person with a disability and/or disabled

Visible Minority

2SLGBTQ+ (https://www.trentu.ca/currentstudents/sites/trentu.ca.currentstudents/files/documents/Defining%202SLGBTQ+%20Terms%20OoC.pdf)

Other:

Select all accessibility services that you require and/or would utilize throughout the conference. *

Audio Captioning

Audio Translation (English to French)

Audio Translation (English to ASL)

Audio Translation (English to other - please specify in "other" category)

Audio descriptions of images

Receive slides in advance

Other:

Required

Please select your top two objectives for this conference. *

Connecting with other young leaders

Building skills to have difficult conversations

Deepening my knowledge on discrimination in Canada

Learning how to create positive social change

Other:

Required

What made you decide to partake in this conference? What do you hope to get out of this program? *

Here are some examples: a clear way forward for a specific project, a general understanding of social issues, improving communication and listening skills regarding difficult subjects, etc.

Is there anything else you would like us to know?

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