Centre for Race and Culture - KLA Application Form

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KLA Application Form

Student Information

Name

Mailing Address

Date of Birth

Home Phone

Cell Phone

School

Grade

Status (choose one)

Canadian Citizen
Permanent Resident
Refugee
Other

Name

Mailing Address (if different from student)

Home Phone

Work Phone

Favorite sport

Favorite musical acts:

In my spare time I like to:

Favorite movies & TV shows:

Previous leadership experience:

Career goals are:

Special skills & talents:

Areas I'd like like to improve in:

What I want to get out of the KLA:

Extracurricular activities:

Some info about my ethnicity & heritage:

Enter characters displayed to the right.

for an inclusive society

Cree Language Lessons- Feb 7, 2012-June 18, 2012 (FULL)