Step Out of your Box Program – Registration Form

This program is designed to give students the opportunity to explore and develop an understanding of the many dimensions of diversity that make us unique individuals and also to connect students with others in a meaningful way that builds skills and develops awareness and understanding of the diverse world we live in.

Four awards of $500 each are presented annually to four projects submitted by students who spend time exploring a dimension of diversity different from their own and produce a leave-behind project that promote the dimension of diversity the student has chosen and/or benefiting the organization the student was volunteering for.

Please fill out the following form to register to the Step Out of your Box Program.

REGISTRATION FORM

Your Name (required)

Your Student Number (required)

Your Email (required)

Your Phone Number (required) (Please use the following format: 204-xxx-xxxx)

Your RRC Program (required)

Your RRC Campus (required)

PERMISSIONS

This final section requests your permission in 3 areas. Please read the following carefully!
YOU MUST READ AND CLICK ALL 3 BOXES BELOW IF YOU AGREE.

WHEN YOU ARE DONE, please click "Send" to submit your application.

SHARING INFORMATION

1. I give Red River College permission to use the information above for screeing and eligibility purposes in the Step Out Of Your Box Program.

SHARING MY STORY

2. I give Red River College permission to use the feedback I provide about my program experience for the purposes of sharing testimonials with the College in support of the program.

SHARING MY PHOTOS, ETC.

3. By checking the box below, you are stating: I hereby consent to each and every use by the Board of Governors of Red River College (the “College”), and all of its officers, employees, agents, and partners, of each photograph and any other likeness of me. Such uses may include, but are not limited to: Every use in a program, catalogue, schedule, newspaper, brochure, advertisement, or other publication or recording that describes, portrays, publicizes, or advertises the College or any College operation, and every reproduction, republication, and other re-use of the same. I also hereby waive any right to compensation for such uses, and any right to inspect or approve the uses beforehand.

I hereby release the College, its legal representatives, and all persons acting under its permission or authority, from any liability by virtue of any blurring, distortion, alteration, optical illusion, or use in composition form, whether intentional or otherwise, that may occur or be produced in taking of said picture or in any subsequent processing thereof, as well as any publication or other uses thereof. I understand that these photographs or other likeness may be used only for educational or College promotional purposes or for the dissemination of information relating to the College in general.

I declare that I am of legal age and have every right to contract in my own name in the above regard.

Red River College is governed by the Freedom of Information and Protection of Privacy Act of Manitoba (FIPPA) in the collection, use, retention, safeguarding, disclosing and disposing of personal information. The personal information you provide will be used to deliver services and benefits related to the Mentorship Program. If you have any questions or concerns, contact Red River College’s Privacy Co-ordinator at Privacy@RRC.CA.

 

Red River College is governed by the Freedom of Information and Protection of Privacy Act of Manitoba (FIPPA) in the collection, use, retention, safeguarding, disclosing and disposing of personal information. The personal information you provide will be used to help us assess your request and contact you about your request. If you have any questions or concerns, contact Red River College’s Privacy Co-ordinator at privacy@rrc.ca.

We ask that you please do not reveal personal health information in the fields above.