TALK AT THE TOP SUMMIT APPLICATION

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Thank you for your interest in attending the Talk at the Top Jack Summit! If you are filling out this form, it means you are applying as a delegate to the summit. 

Please provide us with a few details below.
General Info
mm/dd/yyyy
###-###-####
Please ensure these emails match and are spelt correctly
Region
Schooling
Language
Note: This summit will be conducted in English. Should you prefer to be communicated in French, we can note that preference for future non-summit communications. However, all communications with respect to this summit will remain in English.
Demographic Info
In this section, we will ask you questions about how you identify. In our commitment to equity and inclusion, we are gathering this data to help us (1) better understand the youth we work with, (2) identify the gaps in our programming, and (3) build pathways to break down barriers to participation. This data will also allow us to represent what we learn through our surveys and represent those findings more accurately. We understand that can be sensitive information, so we want to reassure you that this information will remain confidential and secure. Please feel free to select ‘prefer not to say’ if you feel uncomfortable answering any of these questions.
Select all that apply. Note: cisgender means gender is the same as assigned at birth.
Select all that apply.
Jack.org Experience
Virtual Accessibility Considerations
Our virtual summit will take place primarily over streamed video and an event app, Whova. We also offer a call-in option if you cannot log in to our video platform.
Application Questions