Experiences Canada
 

Experiences Canada ONLINE APPLICATION FORM

Please note that priority will be given to those applications containing strong historical content. Experience Canada's vision is to promote an environment in which all Canadians take full advantage of dynamic cultural experiences, celebrate our history and heritage, and participate in building creative communities.

Please note to ensure the safety security of the youth participating in an exchange all volunteers and adults over the age of 18 living in the host family household are required to provide clear police record and vulnerable sector checks.

As the group organizer you agree that all youth participants are new to the exchange program. Any returning youth may participate, however they will be unsubsidized.

1. Group Identification
Type of group: School-based Community-based  
Name of school/group
Street Address 1
Street Address 2 (Optional)
City Prov./Terr.  Postal code 
Telephone Number Telephone Ext.
Fax Number
E-mail Address
Website Address


Group Organizer's Salutation   Mr.        Mrs.       M.       Mme       Ms.
Group Organizer's First Name
Group Organizer's Last Name
Home Address 1
Home Address 2 (Optional)
City Prov./Terr.  Postal code 
Telephone Number (Home) Telephone Ext.
Mobile Number
E-mail Address
if you are a school group, what is your school board?
 
Principal or Supervisor (Must be different to Group Organizer)
Title or Role
Salutation:
  Mr.        Mrs.       M.       Mme       Ms.

Name of authorized signing officer of school or organization (must be different than group organizer name)
First Name: Last Name:

Daytime telephone number where he/she can be reached:
Ext.

E-mail Address:

What language do you want to correspondent with us?     English      French

 

2. Group Profile
NOTE:
  • If you have both male and female youth in your group, please include one male and one female chaperone in the group.
  • The subsidized chaperone ratio is
    Groups of 10 to 20 youth: 2 chaperones
    Groups of 21 to 30 youth: 3 chaperones
a) Estimated number of participants:
(Groups must consist of a minimum 8 youth and 2 adults)
 Females
 Males
 Female Chaperones
 Male Chaperones
 


b) Can you be flexible in the size of your group?


 Yes       No


c) If yes. Please indicate:


MINIMUM number:      MAXIMUM Number:


d) Age range of youth:


MINIMUM Age:     MAXIMUM Age:


e) Can you be flexible in the age of the youth in your group?


 Yes       No


f) If yes, please indicate age range:


MINIMUM Age:      MAXIMUM Age:


g) Grade level(s) of the participants




h) Mother tongue of participants in the group:


 English     French     Other
  Specify:  


i) Do you have previous experience in organizing an exchange?


 Yes       No


j) Are you applying to any other Exchanges Canada delivery organization at this time?


 Yes       No

If yes,

 YMCA        Canada Sports Friendship Exchange Programs
   Canadian 4-H Council
   Other  
 


3. Group Description

a)   Are you taking a pre-existing group (e.g. members of one grade 8 class, scout group, drama club, student council, sports team), or has your group been formed for the purpose of this exchange.

 Pre-existing group                  Group formed for this exchange                  Group not yet formed

b)   If forming a group specifically for the purpose of taking part in this exchange, how are you selecting the participants?






c)   We encourage the participation of youth who have traditionally been under-represented in exchanges. Please indicate if your group includes youth who fall within the following groupings: (please see Definitions on page 5 of the Application Guide)


  (1) Youth with Special Needs and/or Disabilities?  Yes   No
  A person with a long-term physical condition, mental condition, or health problem, who is limited with respect to functions in the home, in school or other activities (e.g. leisure time activities) If yes, approximately how many total?  
 

(2) Youth from low-income households?


 Yes   No
  A person who lives in a household earning less than the Low Income Cutoff as defined by Statistics Canada If yes, approximately how many total?  
 

(3) Visible minority youth?


 Yes   No
  An individual, other than an Aboriginal person, who is non-Caucasian in race or non-white in colour If yes, approximately how many total?  
 

(4) Aboriginal youth?


 Yes   No
  A member of a First Nation, a Métis or an Inuit If yes, approximately how many total?  
 

(5) Youth from rural or isolated areas?


 Yes   No
  A person who lives in a community with a population less than 10,000 If yes, approximately how many total?  

Do you expect to need any additional support to meet the needs of these participants (e.g. financial assistance for low income participants, sign language interpreter, modified vehicle, transportation, accessible home)?
(please see Special Measures on page 5 of the Guide)

 Yes            No           Not sure

d)    What is the nearest major airport to your community    
        What distance (in km) are you from this major airport?          kms


e) Special Travel Requirements
 

 

4. Exchange Description
a)  Please indicate the PRIMARY educational focus of your exchange (select only one):

 

    Specify: 

If a match is not found for the PRIMARY educational focus of your exchange, would you consider other possibilities?
    Yes No


b)  Is there a secondary education focus/theme you wish to select for your exchange? :

 

    Specify: 


c)  Are you applying for a bilingual exchange?       Yes        No

Would you prefer to be twinned with any of the following groups?
       


d)  If it is not possible to match your group with another group wishing to do a bilingual exchange, would you like to be considered for an exchange with a group whose maternal language is the same as yours?
Yes       No




e) Is your group an Official Minority Language Community (OMLC) group? (At least 75% of participants are Francophones living outside of Québec or Anglophones in Québec)
 Yes        No


f) If yes, would you like to be twinned with another OML group?
 Yes        No


g) If yes, and another OML group wasn't available, would you consider a non-OML group?
 Yes        No


h) If you are not an OML group, are any participants in your group members of an Official Language Minority Group?
 Yes        No         If yes, approximately how many?  


i) I am applying for the Human Rights exchange with Experiences Canada and the Canadian Museum for Human Rights:
 Yes        No


j) I am applying for the Immigration and Diversity Exchange with Experiences Canada and the Canadian Museum of Immigration at Pier 21
 Yes        No


k) I am applying for the Destination 2017 Exchange with Experiences Canada and Ottawa 2017
 Yes        No

 

5. Objectives
The objectives of our programs are:
  • To develop a greater understanding of Canadian History and Heritage;
  • To offer Canadians opportunities to learn about Canada and to experience the cultural richness of our country;
  • To foster appreciation of both the diversity and the shared aspects of the Canadian experience;
  • To foster a strong sense of Canadian identity and pride.
Please check the activities that you are planning to include in your exchange program to achieve Exchanges Canada's objectives:

5.a - Before the exchange (Please check any that apply)
      Research home community
      Research twin community
      Develop joint project with twin group
      Encourage parents to communicate
      Encourage participants to communicate by e-mail
      Encourage participants to communicate by phone
      Encourage group correspondence
      Prepare introductory video
      Fundraising
5.b - During the exchange (Please check any that apply)
      Develop group activities to encourage interaction among participants
      Work on a joint project
      Involve the community as a whole — potluck suppers, etc.
      Visit local attractions
      Schedule free time with families
      Document the exchange through videos, journals, photos, etc.
5.c - After the exchange (Please check any that apply)
      Encourage participants to keep in touch by phone, letter or e-mail
      Inform the community about the exchange — presentations, media coverage
      Prepare scrapbooks and photo albums
      Prepare presentation and deliver it to local feeder schools, school board
      Develop project website
 

6.  Specific Requests (Optional)
Please note:  All groups applying to the program are considered individually for eligibility. Requesting a specific twin group does not change your group's eligibility. Experiences Canada must respect established provincial/territorial targets to ensure the equitable national distribution of the funds allocated to this exchange program. Requests for specific twinnings or locations are considered in light of these provincial and territorial targets and budget limitations once the eligibility of both groups has been determined.

a)  Are you requesting a specific twin group?  

b)  If you are requesting a specific twin, please complete the following. Both groups must apply seperately to Experiences Canada, indicating their twin.

Name of Twin School/Group Requested
Street Address
City Prov./Terr.  Postal Code 
Telephone Number Fax Number
 
 
 
Twin Group Organizer's Identification
Twin Group Organizer's First Name
Twin Group Organizer's Last Name
Twin Group Organizer's E-mail Address
Twin Group Organizer's Telephone Number
Twin Group Organizer's Fax Number
  

c)  If the specific twinning or location you have requested is not approved, will you consider other possibilities?
 Yes       No

d)  How did you hear about Experiences Canada?  


7.  Exchange Period
Please indicate in which period you would like to travel & host.

 Summer 2017        School Year 2017-18 (Sept. 2017 to June 2018)
 Summer 2018        School Year 2018-19 (Sept. 2018 to June 2019)
 Summer 2019      


Preferred Travel Month  

Preferred Hosting Month  


8.  Agreement
Due to a high demand for exchanges, not all applications to the program will result in an approved exchange. Experiences Canada tracks all groups' history to ensure that everyone has equal access to the program.  Please note if your application is selected for funding the group is required to pay a $100 per person registration fee.

Privacy Policy   FAQ

I have read the Application Guide and my group can comply with all of the criteria.
I understand that my application will not be complete until the following items are received by Experiences Canada:

$100 membership fee
Agreement of School or Organization
Agreement of Group Organizer
Yes       No