Registration Form Youth Action Gathering August 2012

Please fill out the form below to submit your application to participate in the CCR Youth Action Gathering.

Unfortunately, the CCR can only offer 60 spots for candidates because of a lack of space in the rooms where the workshops are given and due to a limited budget. In the selection process of the 60 participants, the CCR will give priority to people who:

(You do NOT have to meet all of the criteria to apply!)

are 25 years old and under or involved with newcomer youth in their community
had the experience of coming to Canada as a refugee or (im)migrant
are involved with newcomers in their community
are currently involved in the CCR Youth Network
are involved in organizing the Youth Action Gathering (workshop facilitator, moderator or organizer)
demonstrate their potential to stay involved in the CCR Youth Network after the Gathering

The CCR will take into account regional representation in the selection process, and encourages applications from people of colour, gay, lesbian, bisexual, trans, and queer people.

Please note that candidates from outside of Montreal can apply for the CCR Youth Travel Fund which will cover a part of the transportation fees. We ask participate to apply for the fund only if they have a financial need.

The deadline to complete the form below is 17 June for applicants from outside of Montreal, and August 17th for applicants living in Montreal.

Don't hesitate to contact kfortier [at] ccrweb [dot] ca if you have any question.

Please be informed that we will only share the information that you provide below with people who are involved in organizing the Gathering, and only for the purpose of organizing the Gathering. We will also provide this information anonymously to workshop facilitators.

Personal Information

Name : *

Last name : *

Age : *

Sex : *

Have you had the experience of coming to Canada as a refugee or an (im)migrant? : *

Yes

Address : *

City : *

Province or Territory : *

Postal Code : *

Telephone Number : *

Email : *

Contact Information : *

Yes

The CCR will compile a document with all of the participants' contact information so that they are able to stay in touch after the conference. Do you accept that your phone number, address, and email be added to this list?

What is your preferred language of communication? : *

Do you understand and/or speak French? : *

I only understand it

Yes, I understand and speak it

No, I neither understand nor speak it

Do you have food-related restrictions or allergies? : *

If so, please specify: :

Do you need childcare services? : *

Yes

The CCR will offer childcare if your child is potty trained.

Special Needs : *

Please indicate any special need. The CCR will accomodate you to the best of its ability.

Your motivations

Are you currently involved the CCR Youth Network? : *

Yes

If so, please specify how you are involved: :

Are you involved in organizing the Youth Action Gathering? : *

Yes

Ex: as a facilitator, moderator, workshop organizer, volunteer, etc.

If so, please specify how you are involved: :

Please explain in 200 words or less why you want to participate in the Youth Action Gathering, and what you hope to gain from it. : *

Please describe in 300 words or less your involvement with newcomers in your community. : *

After the Gathering, how do you plan to use this experience to address the obstacles that newcomers face in your community? (maximum: 200 words) : *

Youth Travel Fund

Attendance at the Youth Action Gathering is free, and we only ask for voluntary donations for social activities. However, the CCR recognizes that participants coming from outside of Montreal may experience financial difficulties in terms of travel costs. In order to reduce these costs in a fair manner, the CCR has established a single average cost of 465$ for each participant from outside of Montreal who applies for the fund, regardless of their location. Should the participant apply for the Youth Travel Fund, the CCR will cover half of that amount, on the condition that the participant fundraises over the course of the summer to cover the other half, that is $232,5 (this amount may vary depending on the locations of the selected participants).

20 participants (or less) will be beneficiaries of the Youth Travel Fund. We ask you to apply for this fund only if you experience a financial need and if your travel costs exceed 232,5$.

Would you like to apply for this fund, knowing that you will have to do fundraising to cover part of the travel costs? : *

Yes

More details will be given once the selection process of the participants is completed.

This fund was created to help bring participants to the conference who would not other wise be able to attend. Please explain your financial need (maximum 150 words). : *

On-site Accomodation

The CCR will work to the best of its ability to find 20 places in CCR members and allies’ homes to host participants coming from outside of Montreal during the 2 nights of the Gathering (the night of August 31st and the night of September 2nd).

If you live in Montreal, please specify if you can host participant(s) during the Gathering: : *

Yes

If so, please specify the number of participants that you can host and for which night(s): :

If you are from outside of Montreal, please indicate if you need a place to stay during the Gathering: : *

Yes

If so, please specify for which night(s) you need a place to stay: :

night of August 31st

night of September 1st

Open Mike Night

We will be having an open mike night during the second night of the Gathering. All performances are welcome, including signing, music, dance, improvisation, poetry, etc.

Do you want to be part of the show? : *

Yes

If so, please indicate what you’d like to present, knowing that you’ll be responsible for any instruments and extra equipment that you’ll need. You will have access to a mic and speakers. :

Vous aurez toutefois accès à un microphone et haut-parleurs.

Promoting Your Group/ Organization

During the Gathering, there will be a table reserved for promoting participants’ organizations or community groups. We encourage participants to bring promotional materials and resources from your organization/group to contribute to this table (flyers, brochures, posters, information booklets, pins, etc.). However, please note that your materials must be distributed free of charge. We are not able to supervise the sale of your materials.

Do you want to contribute materials to this promotion table? : *

Yes

If so, please specify the nature and the quantity of your materials (example: 40 flyers) :

Langues

Conseil canadien pour les réfugiés

Registration Form Youth Action Gathering August 2012