Soaring Shell Canada School Grant Registration Form

Winnipeg, MB March 22 -23, 2018

The Shell Canada School Grant Program will provide $20,000 in funding for schools in its communities of interest to attend the 2018 Soaring: Indigenous Youth Empowerment Gathering. Eligible schools can use this form to apply for up to $2,500 in funding to offset travel costs for students and a chaperone.
Registration Request Deadline: January 22, 2018

Confirmations for accommodations will be sent on January 29, 2018.

Once the application is approved a participant release form will be emailed to the lead chaperone to be completed for every attendee.

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* 1. Today's Date:

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* 2. Which community are you from?

Contact Information:

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* 3. School /Organization Name:

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* 4. School Division:

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* 5. Primary Contact Name(s):

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* 6. Title/Position:

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* 7. Lead Chaperone Name(s):

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* 8. Primary Phone Number(s):

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* 9. Primary Email:

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* 10. School/Organization Address:

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* 11. Town/City:

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* 12. Province:

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* 13. Postal Code:

Participant Information

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* 14. Grade Levels of Students attending (Grades 7,8,9,10,11,12):

Grade 7

Grade 8

Grade 9

Grade 10

Grade 11

Grade 12

Other (please specify)

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* 15. Our School is (Check all that apply)

On - Reserve

Urban

Rural

Northern

High North

Isolated

Travel
Please indicate the approximate number of hours that you will need to drive one-way from your school or community to attend this event.

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* 16. Number of hours (Estimated in hours)

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* 17. Number of KM (Estimated one way in KM)

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* 18. Estimated Arrival Date & Time:

Date / Time

Date

Time

AM/PM

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* 19. My school's requested grant is: (maximum grant is $2,500)

Complimentary Hotel Room Request
A limited number of rooms will be available for eligible groups.

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* 20. Our group is traveling more than 3 hours one way and would like to be considered for complimentary hotel accommodations.

Yes

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* 21. Room Nights

One night (March 21, 2018)

Two nights (March 21 - 22, 2018)

Three nights (March 21-23, 2018)

No rooms requested

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* 22. Number of Rooms being requested (Including Chaperones and Students) We recommend 4 students per room:

Total Number of Rooms:

Venue/Event Preference

2018 Soaring: Indigenous Youth Empowerment Gathering
Limited tickets are available.

Thursday, March 22, 2018 - 8:30 am - 3:30 pm
RBC Convention Centre, Winnipeg, MB

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* 23. Soaring Total Number of Students:

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* 24. Soaring Total Number of Chaperones:

2018 Indspire Awards
Limited tickets are available.

Friday March 23, 2018 - 8:30pm - 10:30pm
Centennial Concert Hall
555 Main Street
Winnipeg, MB

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* 25. Awards Total Number of Students:

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* 26. Awards Total Number of Chaperones:

2018 Campus Tour
Limited tickets are available.

Friday, March 23, 2018 - 9:00 am - 2:00 pm
Campus Various Locations, Winnipeg, MB

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* 1. Today's Date:

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* 2. Which community are you from?

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* 3. School /Organization Name:

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* 4. School Division:

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* 5. Primary Contact Name(s):

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* 6. Title/Position:

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* 7. Lead Chaperone Name(s):

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* 8. Primary Phone Number(s):

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* 9. Primary Email:

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* 10. School/Organization Address:

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* 11. Town/City:

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* 12. Province:

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* 13. Postal Code:

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* 14. Grade Levels of Students attending (Grades 7,8,9,10,11,12):

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* 15. Our School is (Check all that apply)

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* 16. Number of hours (Estimated in hours)

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* 17. Number of KM (Estimated one way in KM)

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* 18. Estimated Arrival Date & Time:

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* 19. My school's requested grant is: (maximum grant is $2,500)

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* 20. Our group is traveling more than 3 hours one way and would like to be considered for complimentary hotel accommodations.

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* 21. Room Nights

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* 22. Number of Rooms being requested (Including Chaperones and Students) We recommend 4 students per room:

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* 23. Soaring Total Number of Students:

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* 24. Soaring Total Number of Chaperones:

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* 25. Awards Total Number of Students:

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* 26. Awards Total Number of Chaperones:

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* 27. Campus Total Number of Students:

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* 28. Campus Total Number of Chaperones:

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* 29. How did you hear about this conference?

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* 30. Comments