Youth Community Change Cohort Apply Now Question Title * 1. First & Last Name: Question Title * 2. Gender Pronoun/s (i.e., they, she, he): Question Title * 3. Please select each one that you identify yourself as (you can choose more than one): Indigenous: A collective name for First Nations, Metis and Inuit African Nova Scotian: A person of African descent residing in Nova Scotia Persons with a disability Mi’kmaq Indigenous African Nova Scotian LGBTQS2+ Newcomer/ Immigrant Person of Colour or Racialized Person Francophone None of the above Other (please specify) Question Title * 4. Email Address: Question Title * 5. Age: Question Title * 6. Community you live in: Question Title * 7. We will help you design your project, but we’d like to know what type of change you are hoping to make in your community. If selected, what type of project are you interested in creating? Question Title * 8. The program will start on September 16th- 18th at an overnight camp at The Deanery (751 W Ship Harbour Rd, Lake Charlotte, NS). Arrival will be September 16th at 6pm and departure will be Sunday September 18th at 12 noon.If selected, are you able to attend the overnight camp component of the program? Yes No Question Title * 9. Do you require transportation to The Deanery overnight camp? Yes No In accordance with Section 485 of the Municipal Government Act (MGA), the personal information collected through the completion of this form will only be used by municipal staff for purposes relating to the administration and management of the Community Change Cohort Program. If you have any questions about the collection and use of this personal information, please contact the Access and Privacy Office at 902.943.2148 or privacy@halifax.ca. Page1 / 1 100% of survey complete. Done
