Elder and Knowledge Keeper Request Form (Orillia Campus)
Aaniin Boozhoo (Hello),

Please complete this form to start the process of requesting an Elder and/or Knowledge Keeper. Once you complete the request form, the Indigenous Initiatives Coordinator will connect with you within 5 business days.

Please note: this process is not meant to interfere with existing relationships you may have with Indigenous Elders and/or Knowledge Keepers. More so, it is meant to support Lakehead University's relationship with Indigenous communities by honouring Indigenous Peoples' customs in a good way.

This form is solely for the Orillia campus. If you are requesting an Elder and/or Knowledge Keeper from the Thunder Bay campus, please contact:

Yolanda Twance, BA, BEd, MEd, OCT
Coordinator, Indigenous Student Services Centre
Indigenous Initiatives, Thunder Bay
e: coordinator.issc@lakeheadu.ca

Miigwetch (Thank-you). In Kindness,

Mercedes Jacko, she/they [pronounced: mr-SAY-deez JOCK-o]
Indigenous Initiatives Coordinator
Office of Indigenous Initiatives
Lakehead University, Orillia Campus

t: 705-330-4010 ext. 2018
e: orillia.ii@lakeheadu.ca 
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Email *
Name: *
Email: *
Telephone: *
Role: *
Department OR organization: *
Campus: *
If you are a faculty member, what course is this request in relation to? *
Indigenous peoples, languages and teachings are very diverse across Turtle Island; please select which perspective best suits your request: *
Elder and/or Knowledge Keeper: *
Location of the request: *
What are you requesting? *
What is the reason for your request (i.e., event, etc.) *
Date of request: *
Time of request: *
What is the duration of time required for your request? *
Estimated number of participants:   *
Additional questions:
Was there an area missing from this form that would have helped you better explain your request?
I understand by submitting this Elder Request Form, I am agreeing to cover the cost of the Elder's honorarium, associated travel costs, lunch/refreshments, a gift and any cultural customs my request entails. *
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