2021-22 Application Form for the Agents of Change Program

Thank you for applying to the Agents of Change Program!

To apply, please fill out the form below and upload your full project proposal. NOTE: If you are applying as part of a group, you will only need to submit one application. Please assign a group member as a primary contact who is responsible for submitting the application on behalf of the group.

Project proposal templates can be found on our website: https://ccscss.info.yorku.ca/agents-of-change-apply-now/

Deadline to Apply: Sunday, July 4th, 2021 by 11:59PM.

All decisions will be made available in July, 2021.

If you have any questions, please email Abdul k. Mohammed at abdulk@yorku.ca

PRIMARY CONTACT INFORMATION

If you are applying INDIVIDUALLY, please provide your contact information in the space below.

If you are applying as a GROUP, please provide the contact information for the primary group contact. Please remember that contact information of additional group members must be included as part of your proposal.
Name Name * First Last
Student Number *
Email *
Phone Number Phone Number * - ### - ### ####
Faculty *

If you are applying individually - you must be from the Faculty of Health. If you are applying as part of a group, majority of members need to be part of the Faculty of Health.
Program *
Year Level *
Are you applying as a group? *

Are you applying as a group? Yes No
If yes, how many members are in your group (including yourself)?
Please confirm that you and your group members will be attending the "Foundational Peer Leadership Training" that will take place during the Fall 2021 Term.

[Date and Location will be updated soon.]

Please confirm that you and your group members will be attending the "Foundational Peer Leadership Training" that will take place during the Fall 2021 Term.

[Date and Location will be updated soon.] Yes, my group members and I will be attending "Foundational Peer Leadership Training" If you or your group members, have already attended Foundational Peer Leadership Training [FPLT], please mention the names of those individuals below.

The "Foundational Peer Leadership Training" is highly recommended for the Agents of Change program. These training sessions will develop your transferable and leadership skills needed for your future career and personal life. If you have any questions or concerns regarding these training sessions please email abdulk@yorku.ca.
Please confirm that you and your group members will be attending the "Advanced Peer Leadership Training" in the Fall 2021 Term.

[Date and Location will be updated soon.]

Please confirm that you and your group members will be attending the "Advanced Peer Leadership Training" in the Fall 2021 Term.

[Date and Location will be updated soon.] Yes, my group members and I will be attending "Advanced Peer Leadership Training" If you or your group members, have already attended Advanced Peer Leadership Training [APLT], please mention the names of those individuals below.

You must be available to attend the "Advanced Peer Leadership Training" to be eligible for the Agents of Change program. The session is occuring during reading week.
Please confirm that you and your group members will be available to attend the Agents of Change bootcamp/training program taking place the week of July 19-23.

[Time and Location will be updated soon.]

Please confirm that you and your group members will be available to attend the Agents of Change bootcamp/training program taking place the week of July 19-23.

[Time and Location will be updated soon.] Yes, my group members and I will be attending the "Master Your Potential" Bootcamp [training session]

You must be available to attend the Agents of Change training session to be eligible for the Agents of Change program.
Did you attend an information session?

Please note that the Information Sessions will be held on:

Thursday, June 17 from 2-3 PM
Tuesday, June 22 from 12-1 PM
Friday, June 25 from 12-1 PM

Did you attend an information session?

Please note that the Information Sessions will be held on:

Thursday, June 17 from 2-3 PM
Tuesday, June 22 from 12-1 PM
Friday, June 25 from 12-1 PM Yes, I attended No, I did not attend I did not know there were information sessions No, but I plan on attending
Did you attend the Agents of Change Proposal Bootcamp?

Please note that the Proposal Bootcamp will be a two part series, taking place June 29th 2021 from 5-7:30PM, and June 30 from 5-7PM through Zoom.

Did you attend the Agents of Change Proposal Bootcamp?

Please note that the Proposal Bootcamp will be a two part series, taking place June 29th 2021 from 5-7:30PM, and June 30 from 5-7PM through Zoom. Yes, I attended No, I did not attend I did not know there was a proposal bootcamp No, but I plan on attending
PROJECT PROPOSAL SUBMISSION

In the space provided below, you will be able to upload your project proposal for submission. Double check your proposal prior to submitting it to ensure all required information is included. The project proposal template can be found at - https://ccscss.info.yorku.ca/agents-of-change-apply-now/
Name of your proposed project: *

If you are applying for funding renewal, please indicate it here in brackets after your proposed project name. For example: Fix the 6ix (RENEWAL)
Upload project proposal *

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Upload additional information

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2021-22 Application Form for the Agents of Change Program

2021-22 Application Form for the Agents of Change Program

PRIMARY CONTACT INFORMATION

PROJECT PROPOSAL SUBMISSION