Name *

First Name

Last Name

Are you located in Ottawa ? *

Yes

No

Are you in the 14-17 age range? *

Yes

No

in which neighbourhood do you live ? *

Central Ottawa

East End

South End

West End

Gloucester

Kanata

Nepean

Cumberland

Goulbourn

Osgoode Township

Rideau

West Carleton

Please let us know which demographic(s) / priority group (s) represent you. Disclosure of this information is confidential and used solely for the purposes of ensuring diverse representation throughout the consultation process. *

Black

Indigenous

other people of colour

Métis

First Nations

Other

Are you available Monday/Wednesday/Friday 5-8 ? *

Yes

No

What are you interests ?

Music

Videography

Marketing

Other