Experiences Canada ONLINE APPLICATION FORM * The individual in-person program is discontinued. Applications to this program will not be processed. Are you applying to participate in an In-Person Exchange?Please select... Yes No Are you applying to participate as a group or individual?Please select... Group Individual Edit this textChoice A Please note that priority will be given to those applications containing strong historical content. 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.Please note to ensure the safety security of the youth participating in an exchange all volunteers and adults over the age of 18 living in the host family household are required to provide clear police record and vulnerable sector checks.As the group organizer you agree that all youth participants are new to the exchange program. Any returning youth may participate, however they will be unsubsidized. Experiences Canada virtual exchange THIS! Is Canada! connects young people and encourages them to discover the diverse history, geography, languages, cultures and ways of life that shape our country. It supports provincial curricula and is designed for youth from Grades 7-12. Each activity unit is designed with the flexibility to permit teachers/parents-guardians to assign it as an individual or small group work-respecting social distancing protocols, with the majority of tasks completed online. The use of a computer with internet is necessary to complete the modules however, alternatives are available for participants with restricted internet access. Group Information 1. Group Identification (Page 1 of 8) Type of GroupSchoolPrivate SchoolCommunity Organization Name of School/Group Street Address City Province/TerritoryPlease select... State/Province Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territories Postal Code (in A1A 1A1 format) Telephone Number Fax Number Website Address Principal CountryPlease select... Canada If you are a school group, what is your school board? Participant Information 1. Participant Identification (Page 1 of 8) Full Name of Participant Group Organizer Information SalutationMr.Mrs.M.MmeMs. First Name Last Name Home Address Street City Province/TerritoryPlease select... Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territories Postal Code (in A1A 1A1 format) Mobile Number Telephone Number (Home) Email In which language do you want to correspond with us? EnglishFrench Principal CountryPlease select... Canada Parent - Guardian Information SalutationMr.Mrs.M.MmeMs. First Name Last Name Home Address Street City Province/TerritoryPlease select... Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territories Principal CountryPlease select... Canada Postal Code (in A1A 1A1 format) Mobile Number Telephone Number (Home) Email Relationship In which language do you want to correspond with us? EnglishFrench School Principal or Club President (Must be different to Group Organizer and must have signing authority) SalutationMr.Mrs.M.MmeMs. Title or Role Principal First Name Principal Last Name Daytime Telephone Number Email 2. Profile (Page 2 of 8) Group Exchange NOTE: If you have both male and female youth in your group, please include one male and one female chaperone in the group (In-Person Groups only).The subsidized chaperone ratio is:Groups of 10 to 20 youth: 2 chaperonesGroups of 21 to 30 youth: 3 chaperones a) Estimated Number of Participants (In-Person Groups must consist of a minimum 8 youth and 2 adults): Female Youth Please ensure the minimum group size is no smaller than 8 youth x Male Youth Please ensure the minimum group size is no smaller than 8 youth x Female Chaperones Male Chaperones b) Please indicate your group size flexibility: Flexible Group Size - Minimum Please ensure the minimum group size is no smaller than 8 youth x Flexible Group Size - Maximum Please ensure the maximum group size is no bigger than 45 youth x c) Please indicate your age range of Youth: Youth Age Range - Minimum Please ensure the minimum age is no younger than 11 x Youth Age Range - Maximum Please ensure that maximum age is no older then 18 x d) Grade level(s) of the participants6789101112 e) Mother Tongue of ParticipantsEnglishFrenchOther Other Mother Tongue f) Do you have previous experience in organizing an exchange?YesNo g) Are you applying to any other Exchanges Canada Delivery Organization at this time? YesNo If Yes, select Exchange Canada Delivery OrganizationYMCACanada Sports Friendship Exchange ProgramsCanadian 4-H CouncilOther Other Exchange Canada Delivery Organization Virtual Individual Exchange a) Participant Profile Male Youth Please insert 1 if your youth is a male, or 0 if no male youth is attending x Female Youth Please insert 1 if your youth is a female, or 0 if no female youth is attending x c) Please indicate age of Youth: Youth Age Please ensure that maximum age is no older then 18 x d) Grade level(s) of the participant6789101112 e) Mother Tongue of ParticipantEnglishFrenchOther Other Mother Tongue f) Do you have previous experience in organizing an exchange?YesNo g) Are you applying to any other Exchanges Canada Delivery Organization at this time? YesNo If Yes, select Exchange Canada Delivery OrganizationYMCACanada Sports Friendship Exchange ProgramsCanadian 4-H CouncilOther Other Exchange Canada Delivery Organization Group Exchanges 3. Group Description (Page 3 of 8) a) Are you taking a pre-existing group (e.g. members of one grade/class, scout group, drama club, student council, sports team), or has your group been formed for the purpose of this exchange?Pre-existing groupGroup formed for this exchangeGroup not yet formed b) If forming a group specifically for the purpose of taking part in this exchange, how are you selecting the participants?Please select... Have the youth write a letter about their participation in exchange Lottery Other Participant Selection Method Other c) 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 If yes, approximately how many total? (2) Youth from Low-Income Households? A person who lives in a household earning less than the Low Income Cutoff as defined by Statistics CanadaYesNo If yes, approximately how many total? (3) Visible minority youth? An individual, other than an Indigenous person, who is non-Caucasian in race or non-white in colourYesNo If yes, approximately how many total? (4) Indigenous youth? A member of a First Nation, a Métis or an InuitYesNo If yes, approximately how many total? (5) Youth from Rural or Isolated Areas? A person who lives in a community with a population less than 10,000YesNo If yes, approximately how many total? (d) What is the nearest major airport to your community? What distance (in km) are you from this major airport? Do you expect to need any additional support to meet the needs of these participants (e.g. financial assistance for low income participants, sign language interpreter, modified vehicle, transportation, accessible home)?(please see Special Measures on pages 7 and 8 of the Guide)YesNoNot Sure e) Special Travel RequirementsPlease select... Disabled youth Band with instruments Sports team with equipment Indivdual Exchanges 3. Individual Exchange Description (Page 3 of 8) c) We encourage the participation of youth who have traditionally been under-represented in exchanges. Please indicate if your child falls 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 (2) Youth from Low-Income Households? A person who lives in a household earning less than the Low Income Cutoff as defined by Statistics CanadaYesNo (3) Visible minority youth? An individual, other than an Indigenous person, who is non-Caucasian in race or non-white in colourYesNo (4) Indigenous youth? A member of a First Nation, a Métis or an InuitYesNo (5) Youth from Rural or Isolated Areas? A person who lives in a community with a population less than 10,000YesNo (d) What is the nearest major airport to your community? What distance (in km) are you from this major airport? 4. Exchange Description (Page 4 of 8) All exchanges a) Please indicate the PRIMARY educational focus of your exchangePlease select... Human Rights Immigration and Diversity Indigenous - Indigenous (intra cultural) Indigenous - Non Indigenous (inter cultural) International Languages & Cultures - Inter-cultural (e.g. Chinese - English) - specify International Languages & Cultures - Intra-cultural (e.g. Korean - Korean) - specify Official Languages & Cultures - English Minority Language - (EL1) Official Languages & Cultures - English Second Language - (ESL) Official Languages & Cultures - French Minority Language - (FL1) Official Languages & Cultures - French Second Language - (FSL) Theme - Anti-Bullying Theme - Band Theme - Choir Theme - Community Involvement Theme - Cultural Enrichment & Traditions Theme - Dance & Dramatic Arts Theme - Environment Theme - Geography Theme - History and Heritage Theme - Leadership Theme - Religious Groups Theme - Science Theme - Sports Other Primary Educational Focus Other If a match is not found for the PRIMARY educational focus of your exchange, would you consider other possibilities?YesNo b) Is there a secondary education focus/theme you wish to select for your exchange? :Please select... Anti-Bullying Band Choir Community Involvement Cultural Enrichment & Traditions Dance & Dramatic Arts Environment Familiarization Canadian Forces Geography History Leadership Science Sports Other Secondary Educational Focus Other c) Are you applying for a bilingual exchange? YesNo Would you prefer to be twinned with any of the following ?Please select... Core or Basic English Core or Basic French French Immersion Intensive English Intensive French d) If it is not possible to match your application with another application wishing to do a bilingual exchange, would you like to be considered for an exchange with a group or participant whose maternal language is the same as yours?YesNo e) Is your group or child an Official Language Minority Community (OMLC) participant(s)? (At least 75% of participants are Francophones living outside of Québec or Anglophones in Québec)YesNo f) If yes, would you like to be twinned with another OMLC group or participant?YesNo g) If yes, and another OLMC application wasn't available, would you consider a non-OMLC application?YesNo h) If you are not an OMLC group, are any participants in your group members of an Official Language Minority Group?YesNo If yes, approximately how many? 5. Objectives (Page 5 of 8) Objectives Before ExchangePlease select... Research home community Research twin community Develop joint project with twin group Encourage parents to communicate Encourage participants to communicate by e-mail Encourage participants to communicate by phone Encourage group correspondence Prepare introductory video Fundraising Objectives During ExchangePlease select... Develop group activities to encourage interaction among participants Work on a joint project Involve the community as a whole — potluck suppers, etc. Visit local attractions Schedule free time with families Document the exchange through videos, journals, photos, etc. Objectives After ExchangePlease select... Encourage participants to keep in touch by phone, letter or e-mail Inform the community about the exchange — presentations, media coverage Prepare scrapbooks and photo albums Prepare presentation and deliver it to local feeder schools, school board Develop project website 6. Specific Requests (Optional) (Page 6 of 8) Requesting a Specific Twin ?YesNo Twin Group Information Name of Twin - School/Group Requested Twin / Group Street Address Twin / Group City Twin / Group Province/TerritoryPlease select... Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territories Twin / Group Postal Code Twin / Group Telephone Number Twin / Group Fax Number Twin Parent / Group Organizer's First Name Twin Parent /Group Organizer's Last Name Twin Parent / Group Organizer's Telephone Number Twin Parent / Group Organizer's Fax Number Twin Parent /Group Organizer's Email Address How Did You Hear About Exchange Canada?Please select... Colleague who took a group on an exchange Link from another web site Phone call from Experiences Canada Presentation at a conference Experiences Canada booth at a conference Web search Publication ad Email ad Radio Previous Participation on an exchange Other 7. Exchange Period (Page 7 of 8) Exchange Period. Note: Summer 2022 is inclusive of March 2022 - August 20222022 Summer (Mar. 2022 to Aug. 2022)2022-23 School Year (Sept. 2022 to June 2023)2023-24 Summer2023-24 School Year Please indicate your preferred Travel and Hosting periods Preferred Travel YearPlease select... 2021 2022 2023 2024 2025 2026 2027 Preferred Travel MonthPlease select... Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Preferred Hosting YearPlease select... 2021 2022 2023 2024 2025 2026 2027 Preferred Hosting MonthPlease select... Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 8. Agreements (Page 8 of 8) In-Person Exchange Due to a high demand for exchanges, not all applications to the program will result in an approved exchange. Experiences Canada tracks all groups' history to ensure that everyone has equal access to the program. Please note if your application is selected for funding the group is required to pay a $250 per person registration fee.Privacy Policy FAQ Sample Exchange Group Participation Agreement I have read the Application Guide and my group can comply with all of the criteria.I understand that my application will not be complete until the following items are received by Experiences Canada:Yes $250 Group membership fee (this fee does not apply to youth applying to participate individually)Group Organizer Acknowledgement Virtual Exchange Please note if your application is selected for a virtual exchange, the group participation fee is $100 ; or $10 for individual participantPrivacy Policy FAQ I have read the Application Guide and my group/child can comply with all of the criteria.I understand that my application will not be complete until the following items are received by Experiences Canada:Yes Organizer Acknowledgement Contact Information
