history Registration form education Register now! 2SLGBTQ+ History Program: Educator Registration Form Hi! Thank you for your interest in participating in the 2SLGBTQ+ Canadian History Program run by the Canadian Centre for Gender and Sexual Diversity with support from the Department of Canadian Heritage. Please complete the form below to receive your FREE EDUCATIONAL MATERIALS PACKAGE. Questions or concerns? Contact the Program Coordinator, Celeste Lessard-Kragen: commemorate@ccgsd-ccdgs.org. This information is collected for the purposes of data collection and reporting. Step 1 of 3 33% Name* First Last Pronouns*Example: She/Her, They/Them, He/HimEmail* Where are you located?*AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukonOther What level do you work?*Middle SchoolHigh SchoolCollege/University/CEGEPWhat is the age range of the students you teach?14 - 1819 - 2425 - 29OtherName of school or organizationPlease share how many students will be engaging with these materials.How did you learn about this opportunity? Material Use* I understand that I must use these learning materials before 31 March 2020.I agree to have my students complete a brief evaluation form, provided by our funding partner, to share feedback and collect demographic information for in-house reporting. Yes, I agree No, I prefer not I agree to complete a brief evaluation form to provide my feedback regarding the program. Yes, I agree No, I prefer not
