Program Application Form : Piliriaksat Ilitaqsiniq

Program ID

202425KIV161

First name *

Last name *

Home phone number *

Cell phone number

Email address

Address *

Community *

Date of birth *

Gender

Male Female Other

Indigenous identity *

Are you currently enrolled in high school, college or other schooling/training?

Yes No

Are you currently employed?

Yes No

Do you have any allergies or health conditions we should be aware of?

Yes No

Have you applied to any Ilitaqsiniq programs before?

Yes No

Have you participated in any Ilitaqsiniq programs before?

Yes No

Why would you like to take part in this program?

Please describe your experience or current skills with the program topic

Are you able to attend all parts of the program?

Yes No

Children will not be able to attend the program with you. If you have children who are not in school, do you have a childcare plan?

Yes No

Please tell us about any issues you may have with childcare

Please add any other information you would like us to know about you or your application for this program