Online Application Form - Experiences Canada

ARE YOU READY TO APPLY FOR AN EXCHANGE?

Experiences Canada IN PERSON ONLINE APPLICATION FORM

Experience Canada's vision is to promote an environment in which all Canadians take full advantage of dynamic cultural experiences, celebrate our history and heritage, and participate in building creative communities.

1. NOTE

Funding an exchange is subject to the applicant entering into a participation Agreement* with Experiences Canada.
Travel costs for eligible participants are paid by the Government of Canada through Experiences Canada youth exchanges program.
Participating groups are responsible for hosting arrangements, local transportation and costs of activities.
Successful applicants are required to pay $250 registration fee per person after returning the signed Agreement.
All youth participants must be new to the exchange program. Returning youth may participate at their own costs.
To ensure the safety and the security of all participants, all volunteers and adults over the age of 18 living in the host family household are required to provide a clear police record and vulnerable sector checks.

1. Group Identification (Page 1 of 7)

Group Information

Type of Group SchoolCommunity Organization
Name of School/Organization IN FULL (no acronym)	Street Address
City	Province/Territory
Postal Code (in A1A 1A1 format)	Telephone Number
Website Address
Enter School Board name IN FULL (no acronym)	Do you have Board Approval? YesNo

Group Organizer Information

Salutation Mr.Mrs.M.MmeMs.
First Name	Last Name
Home Address Street	City
Province/Territory	Postal Code (in A1A 1A1 format)
Mobile Number (Used for travel updates and emergencies	Telephone Number (Home)
Email	In which language do you want to correspond with us? EnglishFrench

School Principal or Club President

Note: For safety reasons, the organizer named in Section 3 and the Principal/President named in Section 4 cannot be the same person. The Principal/President must have the authority to legally bind and sign the Agreement of participation on behalf of the school, school board or Club.

Salutation Mr.Mrs.M.MmeMs.	Title or Role
Principal First Name	Principal Last Name
Daytime Telephone Number	Email

2. Group Profile (Page 2 of 7)

NOTE: Experiences Canada’s chaperone ratio is 1 / 10:

Groups of 10 to 20 youth: 2 subsidized chaperones
Groups of 21 to 30 youth: 3 subsidized chaperones

a) Estimated Number of Participants (minimum 8 youth and 2 adults):

Female Youth

Please ensure the minimum group size is no smaller than 8 youth

Male Youth

Please ensure the minimum group size is no smaller than 8 youth

Female Chaperones

Male Chaperones

b) Please indicate your group size flexibility (minimum 8 youth and 2 adults):

Flexible Group Size - Minimum

Please ensure the minimum group size is no smaller than 8 youth

Flexible Group Size - Maximum

Please ensure the maximum group size is no bigger than 45 youth

c) Please indicate your age range of Youth:

Youth Age Range - Minimum (12)

Please ensure the minimum age is no younger than 12

Youth Age Range - Maximum (17)

Please ensure that maximum age is no older then 17

d) Grade level(s) of the participants

6789101112

e) Mother Tongue of Participants

EnglishFrenchOther

Other Mother Tongue

3. Group Description (Page 3 of 7)

We encourage the participation of youth who have traditionally been under-represented in exchanges. Please indicate if your group includes youth who fall within the following groupings: (please see Definitions on page 7 of the Application Guide)

(1) Youth with Special Needs and/or Disabilities? A person with a long-term physical condition, mental condition, or health problem, who is limited with respect to functions in the home, in school or other activities (e.g. leisure time activities)

YesNo