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SPARK Summer 2019 Application Form

Page 1

Please consult the SPARK 2019 Application Guide before completing the form.

You are able to complete the form over multiple sessions. In order to do this, you must complete page 1. On the top of page 2, there is a “Save and continue later” option where a unique link will be emailed to you that will allow you to return where you left off. Please be sure not to lose this link.
 
Before submitting your application, you will be able to review your responses, as well as download your responses in PDF format.

Please note: Do not hit the “Back” button on your browser or all unsaved progress will be lost.

If you have any questions about the application or have any difficulties with the technology, please email 
spark@mentalhealthcommission.ca for further help.

PART ONE: PERSONAL AND PROFESSIONAL INFORMATION
1.1 Please provide your information below:
This question requires a valid email address.

It is important that our training group broadly represents various intersecting identities. If you feel comfortable disclosing this to us, please complete the section below. Please note that this section is optional. Information will be kept confidential, and individual responses will not be disclosed.

How do you identify yourself?

I identify myself as:
Registration Fees:

Registration fee for regular participants: CAD$1,165.00
Canadian organization with limited resources/students (limited spots): CAD$395.00

Limited subsidized spots are available. If you would like to apply for a subsidized spot, please also complete the Subsidy Application Form.

N.B. Fees are due within one month of acceptance into the program.
 
 1.2 Please select the area that best describes your work/area of interest: *This question is required.
  • * This question is required.
1.3 Which of the following best describes your level of expertise in Knowledge Translation/Knowledge Exchange: *This question is required.
1.4 Are you applying to the program as an employee of an organization, a volunteer, or as an individual? *This question is required.
If you are applying as an employee of an organization, has your immediate supervisor agreed to your participation in the SPARK training program? *This question is required.
1.6 Participation in the SPARK training program requires some follow-up commitments to ensure that you receive adequate support to follow-through on your plan, and to help evaluate the effectiveness of our approach along the way. These include the following:

a. Submit a completed Knowledge Translation plan within two to three months of the workshop
b. Submit a short (one page) evaluation report on the implementation of your KT plan within nine months of the workshop
c. Participate in short online surveys to help us evaluate the SPARK program
d. Attend two follow-up teleconferences


Are you available to participate in SPARK follow-up activities? *This question is required.
1.8 How did you hear about the SPARK training program? *This question is required.
Would you like to sign up to receive the Mental Health Commission of Canada's newsletter and email communications? *This question is required.