Kenjgewin Teg

374 Hwy 551 / M'Chigeeng, Ontario / P0P 1G0

Anishinaabek Youth Ambassador Program - 2019


Personal Information

This program is made possible, in part, by a partnership with Six Nations Polytechnic and the Ontario Trillium Foundation.

** Pending final Proposal Approval **

Current Address & Contact Information

Cultural Affiliation

(10 digits)


Academic History

Health / Medical Information

Support Network / In Case of Emergency


Culture Participation

Kenjgewin Teg promotes a connection to culture and language, therefore both will be included in the program. Anishinaabek culture includes language, ceremony and use of medicines. Please check to indicate you understand these areas will be explored.

Survey / Research Participation

As Ambassadors, you will participate in Kenjgewin Teg's Centre of Excellence surveys and research. Your responses will remain confidential and anonymous. Data from this research will be kept private and confidential.


Photo & Video Consent

As a participant under one of the training programs/courses offered through Kenjgewin Teg, I give Kenjgewin Teg and its employees:

1. Permission to photograph, videotape, and/or interview me;

2. The perpetual and non-exclusive right and license to use my image, my name, and/or quote from me about contingent work produced by or on behalf of Kenjgewin Teg without payment of royalties to me; and

3. Consent under the Freedom of Information and Protection of Privacy Act to use and disclose my image, my name, and/or a quote from me about contingent work produced by or on behalf of Kenjgewin Teg.

I waive any right to inspect or approve the finished edition.

I release, and agree to hold harmless, Kenjgewin Teg, its employees, and representatives from all actions, claims and demands arising from the Kenjgewin Teg’s collection, use, and disclosure of my image, my name, a quote from me, or a description of my involvement in issues regarding contingent workers.

I am 18 years of age or over, have read this Release before checking below, and accept the terms and conditions.

Freedom of Information and Protection of Individual Privacy

The personal information on this application is collected under the legal authority of the Ministry of Colleges and Universities Act, R.S.O. 1990,c.M.19,s.5 and Regulation 770, R.R.O.1990,s.8. The information is used for the administration and statistical purposes of the College and/or the Ministries and Agencies of the Government of Ontario and the Government of Canada. If you have any questions regarding the collection and use of this personal information, please contact the Registrar of the College.