Indigenous Student Centre - Mini University

Virtual Indigenous Youth Mini-University Application 2021

Otter Program Dates: July 11th-16th

Theme of Earth

Thinking of your future? Let us help you to decide if university fits into that future! Come and virtually experience student life through a unique summer program centered on the theme of water from inter-disciplinary and Indigenous perspectives. Participants will explore various fields of study at Western through interactive online learning with professors, researchers, students, Indigenous mentors and community members.

Please note that youth participants who have not attended the Mini University Program previously will be given priority.

Application Deadline: Sunday May 9th 2021

Applicant's General Information

First Name:

Last Name:

Birth Date:

Birth Month:

Birth Year:

Phone Number:

Age (when program takes place):

Gender:

Current School:

Please check those that apply:
First Nation (Status or non Status) Métis Inuit

Please specify group or nation:

Applicant's Email:

Please note, this email will be used to send relevant links to access online space and zoom for the program

Returning Participant?
Yes No

What is the applicant's T-shirt size? (Adult sizing)

Applicant's Mailing Address

All materials needed to participate in the program will be sent to this address prior to the program dates

Street No. and Name:

Apt./Room No.:

City:

Province:

Postal Code:

About the Applicant (To be completed by the applicant please answer all questions)

What do you see yourself doing in the next 10 years?

Why are you applying to Western's Indigenous Youth Mini University Program? Is there anything specific that you hope to get out of this program?

What are your interests? (e.g. favourite subjects, extra-curricular activities etc.)

Parent/Guardian Contact Information - Primary Contact

First Name:

Last Name:

Day Phone:

Evening Phone:

Cell Phone:

Email:

City of Residence:

Relationship:

Emergency Contact Info and/or Secondary Parent/Guardian Contact Information

First Name:

Last Name:

Day Phone:

Evening Phone:

Cell Phone:

Email:

City of Residence:

Relationship:

Technological Access

Mini-University will continue to be a virtual program in 2021. The Indigenous Student Centre is committed to providing support for students to access the program. Answering no or unsure will not impact your acceptance into the program.

Do you need support with Internet Access?
Yes
No
Unsure

Do you have access to a device to participate (Laptop, Ipad or Tablet)?
Yes
No
Unsure

Do you need any other technological support to participate in the program?
Yes
No
Unsure

If you answered unsure or no, Zeeta, the Community Enhancement Coordinator will meet with you one on one upon acceptance to the program

Medical Information

We request this information in order to ensure that we can meet the health and safety needs of all applicants. We also keep this information completely confidential.

Are there any health concerns (physical, mental, spiritual) that may impact the applicants experience?

Parent/Guardian Consent/Authorization

I/We, the undersigned, parent/guardian of the aforementioned child, do hereby consent to his/her participation in the Mini University summer program.

I/We, the undersigned, parent/guardian of the aforementioned child, do hereby consent to his/her/their participation in the virtual Mini University summer program.
I/We understand that the 2024 Mini-University program will be hosted online using Zoom Conferencing and Microsoft Teams. I/We give consent to my/our child to participant and use this software.
I/We understand that if my/our child is selected to be a part of the program my/our child will need regular access to email through my/our child?s personal email or that of a parent/guardian.
I/We understand that the completion of this application form does not guarantee acceptance into Mini University. I/We understand for the virtual Mini-University 2024 program, program fees will be waived.
I/We acknowledge that if my/our child is selected to attend the program, I/We understand that both myself and my child are required to attend the MANDATORY Parent/Guardian Information Night. I/We understand that failure to attend the mandatory information session by either myself and/or my child will unfortunately result in the removal of the child's name on the acceptance list.
I/We have fully disclosed all information requested on the application form and I/We understand that incomplete, false, or misleading applications may jeopardize my/our child's opportunity to attend the Mini University Program.
I/We understand that there are 2 additional Mini University forms to sign at the Parent/Guardian Information Night. 1) A student contract including code of conduct; and 2) a detailed parent/guardian waiver/consent form.
I/We have carefully read all the information provided including the poster and completed the application truthfully and to the best of my/our knowledge. I/We understand this agreement and hereby consent to have my/our child participate.

I/We, parent/guardian of the aforementioned child, do hereby consent to his/her participation in the Mini University summer program and have agree to the above terms and conditions.

How did you learn about Mini University Program?

To verify that you are a human, please enter the text below:

Application Deadline: Sunday May 9th 2021

Contact Information:

For questions or concerns please contact Zeeta Lazore Cayuga isc.miniu@uwo.ca

Virtual Indigenous Youth Mini-University Application 2021

Otter Program Dates: July 11th-16th

Application Deadline: Sunday May 9th 2021

Applicant's General Information

Applicant's Mailing Address

About the Applicant (To be completed by the applicant please answer all questions)

Parent/Guardian Contact Information - Primary Contact

Emergency Contact Info and/or Secondary Parent/Guardian Contact Information

Technological Access

Medical Information

Parent/Guardian Consent/Authorization

Application Deadline: Sunday May 9th 2021

Contact Information:

Return to the Indigenous Student Centre Website