Winnipeg After-School Program Application Form 2023-2024
Thanks for your interest in the After-School Program for students in grades 8-12 in Manitoba! While we hope to be able to enrol all applicants, we do have a limited number of spots and some eligibility requirements. Please fill out the following form and we will get back to you soon! 

Note: Please fill this out in full, even if you have participated before. 

Thanks so much!

❤️  Charlie & Tiffani
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Email *
What is your first and last name? (Chosen/lived is fine) *
What pronouns do you use? *
What is your phone number?
What is the best email address for us to contact you at? *
How old are you? *
What school do you attend? *
What is your full address? (Participants must be residents of Manitoba) *
Are you a returning member of this program? *
Why are you interested in joining this program? *
How did you hear about this program?
How do you identify your gender identity and/or sexual orientation? (Optional)
This program will take place one evening per month. Please help us find a day of the week to meet that will ensure maximum attendance by thinking about your availability.

Are there certain evenings you cannot meet? (Select all that apply)
Do your parents/guardians/caregivers know you are attending this program? (This will not affect if you can participate, it is just helpful for facilitators to know) *
Please provide information for an emergency contact. This person must be an adult.  (Name, Phone number, Relationship to you) *Please also note if they know you as a different name/pronoun so if we needed to call them, we can respect your confidentiality. *
Are you comfortable with your name and photos from program being shared on Get REAL's social media accounts, websites, and promotional material? (Answer will not affect whether or not you can participate) *
What is your T-Shirt Size? (unisex size, for merchandise sending purposes only) *
Is there anything else that we should know that would be helpful to support your participation in this program? (eg. accessibility needs or information)
This is a leadership program. We will be doing skill building and team building activities, and the nature of the group is structured. We ask that participants commit to attending meetings whenever possible, and let facilitators know if they have to miss. This group will hopefully involve building supports and community connections, but it is NOT a mental health support program. If mental or physical health needs arise during program, facilitators will work with you to access supports in your life outside of the program, including contacting your emergency contact person if necessary. *
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