Indigenous Youth Mini-University Application 2018

Follow your dreams and realize your potential

Thinking of your future? Let us help you to decide if university fits into that future! Come and 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 learning with professors, researchers, students, Indigenous mentors and community members.

Be a part of a select group of youth who live in the new Ontario Hall residence and get access to Western's many facilities including the Athletics Centre and state of the art research laboratories.

Application Deadline: June 4, 2018

Applicant's General Information

Applicant's Mailing Address

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

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

Applicant's Personal Information Please answer each question carefully

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.

Does this youth have any of the following medical conditions?

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 understand that the completion of this application form does not guarantee acceptance into Mini University. I/We understand that Mini University is offered at a cost of $75 per child made payable to Western University at Parent/Guardian Information Night.

I/We acknowledge that is 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 brochure 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.

Application Deadline: June 2, 2017

Contact Information:

For questions or concerns please contact Amanda Myers @ 519-661-2111 x86423 Or Email

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