Young Explorers Program Application

First Name *

M.I.

Last Name *

Email *

Phone

Date of Birth (mm/dd/yyyy) *

Gender

Nationality *

Address

Street Address

Apartment/Unit Number

City

State/Province

Postal/Zip Code

Country

What is your connection to The Explorers Club?

Do you have any physical limitations that would impede hiking or moving in and out of a Zodiac?

YesNo

Please attach your C.V. (Max. file size 5MB)

Section B: General Project Proposal

1. Why do you want to conduct a project on the High Arctic Explorer expedition? *

2. Please describe your proposed project.

3. Adventure Canada actively supports the United Nations Sustainable Development Goals (SDG) for 2030. Please identify if your project aligns with these goals and specifically what SDG’s your project supports.

4. Is your project independent or affiliated with an academic organization? (if applicable please name the affiliated organization.)

5. Where do you expect to research your project—aboard ship, in communities, on the land, or a combination.

6. Describe how you plan to carry out your project. Feel free to reference the itinerary or other Adventure Canada information from the website.

7. Please describe any instruments/equipment that you will use and how/where you will use each of the them.

8. How do you intend to use this project after the voyage?

9. Please explain your perceived interest to the public at large.

10. How do you intend to utilize Adventure Canada expedition team members?

11. Describe a time when you faced a challenge and how you dealt with it.

12. Describe a project you have completed in the past and how you (i) met deadlines, (ii) adapted to unforseen challenges, and (iii) learned from your mistakes.

Section C: Drone Usage

Adventure Canada will be provided all drone footage captured license free for promotional purposes.

1. Do you intend to use a Drone? *

YesNo

2. If yes, please note the make and model of the drone.

3. Please indicate the drone model details.

Note:

It is the responsibility of the Young Explorer to obtain all licenses and permits required for operating a drone in the region/municipality visited. There may be restrictions for drone usage on this itinerary.

Section D: Projects Involving Human Participants

1. Does your project involve participants?

YesNo

2. Does the proposal involve expedition guests?

YesNo

3. Does the proposal involve stakeholders (community members, government employees, etc.) in the regions we visit?

YesNo

4. If yes to any of the above, please explain.

5. Estimate the number of participants you will be recruiting.

6. Please describe how you will recruit participants.

7. Please describe how the research participants will be involved, include the time required of participants.

8. Do you plan to re-contact participants post trip for any purpose? If yes, this must be discussed here and in the consent form given to participants.

9. In what language(s) will the research be conducted?

Section E: Projects Involving Specimen

Does your project involve specimen?

YesNo

Does your project involve collection of specimen?

YesNo

Section F: Signature

1. Permission to promote:

Adventure Canada and The Explorers Club will promote the type of science and the specific projects taking place on board the vessel though their websites, social media, and any other outlets deemed appropriate. I will make this information available to Adventure Canada and The Explorers Club and work with them to ensure appropriate promotion takes place. I understand that my work—online, in print, or elsewhere—must credit The Explorers Club and Adventure Canada, and be tagged appropriately.

I agreeI disagree

2. Permission to publish:

Adventure Canada and The Explorers Club will be notified of published studies or reports so that the results may be shared with passengers and constituents to help promote the knowledge base we are helping to build.

I agreeI disagree

Signature (Please print your name) *

Date (mm/dd/yyyy) *

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