Fort Qu'Appelle Valley Exchange 2017 Application Form
with Canadian Roots Exchange
Who Are We?
We, at Canadian Roots Exchange (CRE), are a group of Indigenous and non-Indigenous youth who believe that in order to bridge the gap between Canada's peoples, we need to become educated and aware of the teachings, triumphs, and daily realities of our Indigenous communities.

Canadian Roots Exchange is a national registered charity (registration number 832296602RR0001) that provides Indigenous based leadership, learning and reconciliation experiences for every youth that participates in our program. CRE organizes three main types of activities: exchange programs, workshops and conferences. Central to CRE programming is the need to bring together Indigenous and non-Indigenous youth. Regardless of the activity, we believe that having dialogue is necessary to foster understanding and reconciliation.

The Exchange - October 5th-8th, 2017

This exchange will take you to the heart of Treaty 4 territory to learn about the region’s history, land and Indigenous health practices. It will be facilitated by the Canadian Roots Exchange team and a team leader from the area who will host us. We will learn from local Elders and community members in the area. Potential excursions include All Nations Healing Hospital and Treaty 4 Governance Centre, as well as land-based activities. We will be leaving for Fort Qu'Appelle on Thursday and leaving Fort Qu'Appelle Sunday morning.

College bursaries are available to cover part or all of the cost.
This opportunity is available to all University of Saskatchewan Health Science students.

For more information contact
heather.exnerpirot@usask.ca (306)966-5770
or
valene@canadianroots.ca (306)966-2964

Name *
Your answer
Last Name *
Your answer
Pronouns
(i.e. she, they, ze, him)
Your answer
Email *
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Telephone *
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Best way to contact you
Birth Date *
MM
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DD
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YYYY
Address
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City *
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Province *
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Postal Code *
Your answer
Are you a registered student in any of the Health Science Colleges at the University of Saskatchewan?
Name of College:
Your answer
Canadian Roots is actively committed to ensuring that we are reaching the diversity of Canada’s population. Do you identify as belonging to an Indigenous community or belonging to a visible minority group? We track this information to ensure that we remain accessible to diverse communities of youth.
I identify as Indigenous to Canada:
Please specify Nation/Community:
Your answer
I am a member of a “visible minority”:
Please specify “visible minority” community:
Your answer
We will be selecting 12 participants for the program. What are you hoping to learn by participating in a Canadian Roots Exchange program?
Your answer
Describe any activities, hobbies or interests that are important to you:
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Do you have any dietary restrictions? *
Please specify your dietary restrictions. This will help with planning meals.
Your answer
Please list any additional information you would like to share and any special considerations that organizers may require: Example mobility issues, allergies... etc.
Your answer
Exchange Costs
CRE typically has program fees to participate in an exchange programs. Fees for the program are generally $150 per day which include all program activities, accommodations, food, lodging and transportation to and from the exchange meeting point. CRE strives to make programs accessible and through our partnership with the College of Nursing and other Health Sciences, bursaries are available to assist those with financial barriers.
If you would like to apply for a bursary, could you tell me what College you are from and we can direct you to the right person to help with the application process. *
Your answer
How did you find out about the exchange? (please check all that apply)
If selected as a participant, when would be the best times to reach you, for an interview and a group pre-departure session? ~These sessions will give you more clarity on what to expect on the exchange and an opportunity to ask any questions and meet the team leaders and other participants coming on the exchange.~ ex: Thursday evenings *
Your answer
Thank you for your interest in the program. If you have any problems submitting this form please email me at valene@canadianroots.ca or find me on Facebook at Valene Cre-erc Thank you! For additional information on our organization, you may also visit www.canadianroots.ca or you could "like" our page on Facebook
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