FREEDOM OF INFORMATION AND PROTECTION OF PRIVACY (FOIP) STATEMENT
The collection of personal information on this form is authorized pursuant to section 33(c) of the Freedom of Information and Protection of Privacy Act (FOIP Act) and will be used for the purposes of assessing and making recommendations regarding your eligibility or suitability for the Minister's Student Advisory Council. If you are selected to attend, you are consenting to the publication of your name, city/town and a mutually agreed-to member profile statement through news releases, to publicize and promote the Conference and the Speak Out program. If you have any questions or inquiries regarding the collection and use of your personal information please contact Kelley Bessette, Speak Out – Student Engagement Initiative, 12th Floor, 44 Capital Boulevard, 10044 108 Street, Edmonton, AB, T5J 5E6, (780) 422-0390.

 
MINISTER'S STUDENT ADVISORY COUNCIL APPLICATION
* Required fields
CONTACT INFORMATION
  First Name *
  Last Name *
  Gender * Male       Female
  Date of Birth *  /   /   (yyyy/mm/dd)  
  Age *
  Address *
  City/Town *
  Postal Code *
  Phone Number (Home) * () -   -    Ext. 
  Phone Number (Cell) () -   - 
  Email *
  Are you a student right now? * Yes       No
PERSPECTIVES
  Based on your perspectives, background and experiences, what would you bring to the Council? (check all that apply) *  
  Rural
North
Dropped out
Full-time employed
Métis
First Nations
Immigrant
Person with a disability
French Immersion
Urban
In school
Graduated
Part-time employed
Inuit
Visible Minority
English as a Second Language
Francophone
Other
 
TELL US ABOUT YOURSELF
  Your answers to the following questions will help us get to know you a bit better. Please limit your answers to 100 words for each question. *  
 
  What accomplishments are you most proud of and why?
  
  Think about an issue you are passionate about. Why is this issue important to you? Why does the Minister need to know about this issue?
  
  Why do you want to be a Council member?
  
  What else do you think we should know about you?
  
 
  If you have been involved with Speak Out previously, please check all that apply:  
  Website (www.speakout.alberta.ca)
Speak Out Forum
Speak Out Conference
Minister’s Student Advisory Council
 
GENERAL INFORMATION
  How did you hear about the Minister's Student Advisory Council? *  
  Online at www.speakout.alberta.ca
Speak Out Forum
From a friend
From a teacher
From a parent
From a poster
From the news
From an online ad
From a television ad
From a print ad (in a magazine, newspaper, etc.)
Other
 
 
  Would you like to receive more information on the Speak Out program through e-mail updates?
Yes            No		  
 
 

Please note that your application is not complete until the Parent/Guardian Consent form has been signed by your parent or guardian and received by the Speak Out Team. A confirmation e-mail will be sent upon receipt of your completed application.