Words in Motion: Intro to Cree December 2022 Registration Form What is your full name?* What is your email address?* Enter Email Confirm Email Address* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Have you ever participated in a CRE program, activity, or event before?*YesNoUnsurePrefer not to sayIf you have, how many times?*OnceTwiceThree times or moreUnsurePrefer not to sayPlease enter your current postal code (e.g. A1B2C3):* Which of the following best describes where you currently live?*UrbanRuralRemoteOn-reservePrefer not to sayWhich of the following genders do you identify with? Select all that apply (Cisgender or cis refers to a person who identifies with the gender they were assigned at birth)* Cisgender woman Cisgender man Transgender woman Transgender man Non-binary 2-Spirit Agender My gender is not listed here Prefer not to say Do you identify with any of the genders or sexualities under the LGBTQIA2+ umbrella?*YesNoUnsurePrefer not to sayHow old will you be when the program starts? Please enter the number representing your ageWhich of the following languages do you most often use at home? Select all that apply.* English French Indigenous language(s) My language(s) is (are) not listed here Prefer not to say What is the highest level of institutional education you have completed?*Elementary (Grade 6)Middle School (Grade 9)High School (Grade 12)College CertificateCollege CertificateCollege DiplomaBachelor’sMaster’sPhDPrefer not to sayHow many years of work experience do you have? (This includes all types of full or part time work)*I have no work experienceLess than 1 year1-3 years3-5 years5-7 years7-10 yearsOver 10 yearsPrefer not to sayWhich of the following demographics do you identify with? Select all that apply.* Indigenous Black Person of colour White My demographic is not listed here Prefer not to say Which Indigenous group do you identify with? Select all that apply (This is a self-identification question, you do not need to have Indian Status or be recognized by the government)* First Nation Métis Inuit My Indigenous identity is not listed here Prefer not to say Do you identify as a person living with a disability? (This is a self-identification question, you do not need to have an official diagnosis.)*YesNoUnsurePrefer not to sayConsent* I agree with the Privacy & Consent StatementThank you for participating in this online survey to assess the reach of our activities. CRE will share the results of this survey in a highly aggregated report (no unique identification) to our program funder. Your participation in this survey is voluntary. You may refuse to take part in this survey, skip questions or exit the survey at any time without penalty. You will receive no benefits from participating in this online survey, but your responses will help us improve the program. There are no foreseeable risks involved in participating in this online survey.. If you feel you have not been treated according to the descriptions in this statement, or that your rights as a an evaluation participant have not been honored during the course of this program, or you have any questions, concerns, or complaints that you wish to address, please contact CRE’s Privacy Officer James Arruda at james@canadianroots.ca. You may print a copy of this consent for your records. Clicking on the “Agree” button indicates that: You have read the above statement; You voluntarily agree to participate.CAPTCHA