Indigenous Cultural Competency and Trauma Informed Training: Registration 2022 RM_Stats Last Name *First Name *Email Address *Mobile Number *Phone NumberBirth DateAddress Address Line 1 Address Line 2 City Province, State, or Region Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas, The Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, The Democratic Republic Of The Cook Islands Costa Rica Cote D'ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia, The Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and the McDonald Islands Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iraq Iran Ireland Isle Of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea, Republic Of Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia, The Former Yugoslav Republic Of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States Of Moldova, Republic Of Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territories Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Barthelemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and The Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands Spain Sri Lanka Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Taiwan Tajikistan Tanzania, United Republic Of Thailand Timor-leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Country Postal or Zip Code Do you need any accommodations for accessible media, such as closed captioning, keyboard accessibility, automatic transcripts, screen reader support, etc.?Select an option * Yes No Please elaborate I hereby grant permission to York University’s Glendon Campus and its representatives to take photographs, videos, or recordings of myself. I further grant to York University’s Glendon Campus and its representatives the right to reproduce, use, exhibit, display, broadcast and distribute these images and recordings in any media now known or later developed for promoting, publicizing, or explaining York University’s Glendon Campus and its activities and for administrative, educational or research purposes. Photographs, video images and voice recordings are the property of York University’s Glendon Campus.Select an option * Yes No I hereby grant permission to York University’s Glendon Campus to use my name with these images and recordings.Select an option * Yes No I give York University’s Glendon Campus permission to contact me about future campus programs, events, and activities.Select an option * Yes No How did you hear about us? * Are you affiliated to Glendon Campus of/or York University?Select an option Current Student Alumni Faculty Staff I do not affiliate with Glendon Campus, York University Do you identify as Indigenous?Select an option * Yes No Are you interested in applying for the Indigenous bursary to cover the cost of the course? By selecting this option, you agree to a validation of Indigenous identity process. * Yes No Please confirm your email address. We will send you a questionnaire to provide verification of Indigenous identity. Please Read Below Before Submitting:To complete your registration, please click on the "submit" button below and kindly wait to be redirected to the product and billing page.If you applied for the Indigenous bursary, please click on the "submit" button below and ignore the product and billing pages. We will contact you shortly with a questionnaire to provide verification of Indigenous identity.Thank you so much for your interest in our program! Note: It looks like JavaScript is disabled in your browser. Some elements of this form may require JavaScript to work properly. If you have trouble submitting the form, try enabling JavaScript momentarily and resubmit. JavaScript settings are usually found in Browser Settings or Browser Developer menu.