Thank you for your interest in attending the ACTIVATE BC Youth Leadership Forum and becoming an ACTIVATOR! Please ensure you fill out the application form below in its entirety. All information submitted will remain confidential.
The application must be completed in one sitting (you cannot save and return to complete it another day). We therefor strongly encourage you to "copy and paste" the questions in a word document, completing the answers on this document on your own time, then return to this online form and "copy and paste" in your responses. This will also allow you to keep a copy of your application for your records and will minimize incomplete and duplicate applications received on our end.

If you have trouble with the on line application or have any questions, please contact Courtney Stevens, ACTIVATE Program Coordinator, at courtney@motivatecanada.ca or call toll free at 1-866-378-3361 ext. 225.

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* 1. Last Name:

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* 2. First Name:

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* 3. Mailing Address:

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* 4. City:

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* 5. Province/Territory:

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* 6. Postal Code:

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* 7. Primary Phone [with area code - e.g. (613) 789-3333]:

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* 8. E-mail Address (please provide the e-mail address that you check and use most often):

If your permanent address differs from the one above, please fill in following:

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* 9. Permanent Mailing Address:

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* 10. Permanent City:

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* 11. Permanent Province/Territory:

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* 12. Permanent Postal Code:

ACTIVATE BC aims to bring together a diverse group of people and be inclusive with regards to participation in this program. The following questions will help us learn more about the diversity of people applying to this forum.

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* 13. Date of Birth (MM/DD/YYYY):

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* 14. Gender Identified as:

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* 15. Ethnicity/Cultural Background:

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* 16. What is your desired language of correspondence?

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* 17. Do you have a disability? If so, what type of disability.

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* 18. If you have a disability, do you require the assistance of an attendant?

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* 19. If you require an attendant, would your attendant be traveling with you and assisting you throughout the forum?

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* 20. If requiring an attendant, would you also require additional funding for your attendant to travel with you?

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* 21. Are you a Canadian Citizen or Permanent Resident of Canada?

EMERGENCY CONTACT: Please provide the contact information of someone that we can call if you are unreachable:

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* 22. Full Name:

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* 23. Relationship to you:

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* 24. Primary Phone (with area code):

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* 25. Secondary Phone (with area code):

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* 26. Contact E-mail:

APPLICATION FORM
APPLICANTS MUST ANSWER ALL THE FOLLOWING QUESTIONS TO BE CONSIDERED:

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* 27. Please tell us why you would like to attend ACTIVATE BC (200 words of less)

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* 28. How has sport, physical activity, and/or recreation influenced your life? (200 words of less)

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* 29. What are three of your greatest strengths that you would bring to ACTIVATE Vancouver? (please state 3 words only)

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* 30. What does your community mean to you (community can be your hometown, school, sports team, etc.)? Is there anything you hope to change in your community?
(300 words of less)

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* 31. If you are affiliated with a community organization, sports organization, or other partner organization such as MoreSports, please list it:
(MoreSports Hubs include...English Bay, Inner City, Hastings, East Central, East Fraserview, South Central, Marpole)

The following questions are for information purposes only and will not directly affect your eligibility to attend ACTIVATE BC.

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* 32. How did you hear about this forum?

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* 33. BONUS: If you would like to submit a video or photograph that represents yourself and your interest in being part of ACTIVATE BC please write "yes" and send those files to courtney@motivatecanada.ca
(examples: photograph playing a sport, short video show casing your community involvement...)
Please tell us if we should expect anything from you.
*Please note this is NOT required.

Thank you for your interest in becoming a delegate at the ACTIVATE Vancouver Forum and for taking the time to fill out this application! If you have any questions, please contact Courtney Stevens, ACTIVATE Program Coordinator, at courtney@motivatecanada.ca or 1-866-378-3361 ext. 225.

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