NOTE: You will not be able to save your application to work on at a later time. Please complete all the required information and submit your form at one time. Location Location ? - Select -GTA & SurroundingOther Please tell us where you are located in Ontario. GTA Date Request Time of Program - Select -MorningAfternoon Morning: 8:00 am to 12:00 pm, Afternoon: 12:00 pm to 4:00 pm Date - First Choice Date - Second Choice Date - Third Choice Other Ontario Program Locations and Dates We are visiting the following locations outside the GTA on the dates indicated: Location Dates Central Ontario: Barrie, Burk's Falls, Gravenhurst, Huntsville, Kearney, Orillia, Parry Sound January 28-February 1, 2019 Eastern Ontario: Barry's Bay, Kingston, Pembroke, Perth, Quinte West, Sydenham, Trenton April 23-26, 2019 North Central Ontario: Cochrane, Geraldton, Hearst, Kapuskasing, Marathon, Smooth Rock Falls, Timmins May 21-24, 2019 Northwestern Ontario: Dryden, Fort Frances, Kenora, Pickle Lake, Red Lake, Sioux Lookout, Thunder Bay June 10-14, 2019 Choose a Location - None -Eastern OntarioCentral OntarioNorth CentralNorthwestern Eastern Ontario 1st Choice - None -April 23 AMApril 23 PMApril 24 AMApril 24 PMApril 25 AMApril 25 PMApril 26 AMApril 26 PM Dates: April 23-26, 2019 Eastern Ontario 2nd Choice - None -April 23 AMApril 23 PMApril 24 AMApril 24 PMApril 25 AMApril 25 PMApril 26 AMApril 26 PM Dates: April 23-26, 2019 Eastern Ontario 3rd Choice - None -April 23 AMApril 23 PMApril 24 AMApril 24 PMApril 25 AMApril 25 PMApril 26 AMApril 26 PM Dates: April 23-26, 2019 Central Ontario 1st Choice - None -January 28 AMJanuary 28 PMJanuary 29 AMJanuary 29 PMJanuary 30 AMJanuary 30 PMJanuary 31 AMJanuary 31 PMFebruary 1 AMFebruary 1 PM Dates: January 28-February 1, 2019 Central Ontario 2nd Choice - None -January 28 AMJanuary 28 PMJanuary 29 AMJanuary 29 PMJanuary 30 AMJanuary 30 PMJanuary 31 AMJanuary 31 PMFebruary 1 AMFebruary 1 PM Dates: January 28-February 1, 2019 Central Ontario 3rd Choice - None -January 28 AMJanuary 28 PMJanuary 29 AMJanuary 29 PMJanuary 30 AMJanuary 30 PMJanuary 31 AMJanuary 31 PMFebruary 1 AMFebruary 1 PM Dates: January 28-February 1, 2019 North Central Ontario 1st Choice - None -May 21 AMMay 21 PMMay 22 AMMay 22 PMMay 23 AMMay 23 PMMay 24 AMMay 24 PM Dates: May 21-24, 2019 North Central Ontario 2nd Choice - None -May 21 AMMay 21 PMMay 22 AMMay 22 PMMay 23 AMMay 23 PMMay 24 AMMay 24 PM Dates: May 21-24, 2019 North Central Ontario 3rd Choice - None -May 21 AMMay 21 PMMay 22 AMMay 22 PMMay 23 AMMay 23 PMMay 24 AMMay 24 PM Dates: May 21-24, 2019 Northwestern Ontario 1st Choice - None -June 10 AMJune 10 PMJune 11 AMJune 11 PMJune 12 AMJune 12 PMJune 13 AMJune 13 PMJune 14 AMJune 14 PM Dates: June 10-14, 2019 Northwestern Ontario 2nd Choice - None -June 10 AMJune 10 PMJune 11 AMJune 11 PMJune 12 AMJune 12 PMJune 13 AMJune 13 PMJune 14 AMJune 14 PM Dates: June 10-14, 2019 Northwestern Ontario 3rd Choice - None -June 10 AMJune 10 PMJune 11 AMJune 11 PMJune 12 AMJune 12 PMJune 13 AMJune 13 PMJune 14 AMJune 14 PM Dates: June 10-14, 2019 If your choices are not available, are you able to host a program on another date during this week? If so, please select 'Yes' and indicate the date and time. Indicate Yes/No - None -YesNo Please Specify Date/Time About Your Group Type of Group - Select -School ElementarySchool SecondaryESLCommunity GroupAdult Grade - Elementary - Select -45678Split Grade - Secondary - Select -9101112Split Describe Split ESL Group - Select -GradeAdult ESL Language Level - None -BeginnerIntermediateAdvancedMixed Specify Mixed ESL Levels eg. Intermediate/Advanced, Beginner/Intermediate, etc. Community Group Type ? Adult Group Type - None -NewcomersSeniorsOther No of People in a Group Select Language - Select -EnglishFrench Special Needs - Select -YesNo Describe Special Needs Timetable One file only.15 MB limit.Allowed types: pdf, docx, doc, jpeg. Contact Information Name Phone Number Type - Select -Office (Day)CellHome Phone Number Email Name of Organization Address Address City/Town ZIP/Postal Code Additional Comments
