CIPR - Blank as Advocacy Series - Registration Form (July 2024)

By registering to Language as Advocacy you agree to comply to the codes of conduct that will be discussed at the beginning of the meeting, and failure to comply will result in your removal from the space.

A registration link will be emailed to you 1-3 business days from the date of registration.

What is your full name?*

What is your email address?*

Enter Email Confirm Email

Have you ever participated in a IYR program, activity, or event before?*

If you have, how many times?*

Please enter your current postal code (e.g. A1B2C3):*

Which of the following best describes where you currently live?*

How old will you be when the program starts? Please enter the number representing your age

Which of the following demographics do you identify with? Select all that apply.*

Indigenous
Black
Person of colour
White
My demographic is not listed here
Prefer not to say

Which Indigenous group do you identify with? Select all that apply (This is a self-identification question, you do not need to have Indian Status or be recognized by the government)*

First Nation
Métis
Inuit
My Indigenous identity is not listed here
Prefer not to say

Consent*

I agree with the Privacy & Consent Statement

Thank you for participating in this online survey to assess the reach of our activities. IYR will share the results of this survey in a highly aggregated report (no unique identification) to our program funder.
Your participation in this survey is voluntary. You may refuse to take part in this survey, skip questions or exit the survey at any time without penalty.
You will receive no benefits from participating in this online survey, but your responses will help us improve the program. There are no foreseeable risks involved in participating in this online survey..
If you feel you have not been treated according to the descriptions in this statement, or that your rights as a an evaluation participant have not been honored during the course of this program, or you have any questions, concerns, or complaints that you wish to address, please contact IYR’s Privacy Officer James Arruda at james@indigenousyouthroots.ca.
You may print a copy of this consent for your records. Clicking on the “Agree” button indicates that: You have read the above statement; You voluntarily agree to participate.

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CIPR – Blank as Advocacy Series – Registration Form (July 2024)