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Quantum Leaps Application

Thank you for your interest in Quantum Leaps! Submit your application via the form below.

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Tell Us About Yourself!

Name:*
Have you been nominated by a teacher for the Quantum Leaps program?*
If you are providing a school-affiliated email, please ensure you can receive messages external to your school
Address:*
Below are some examples of careers in science and technology that some of our eMentors are involved in. Please indicate 2-3 that you are most interested in potentially being matched with, but remember that being assigned a mentor in any of these fields will give you the opportunity to learn more about a career that you may never have thought about.*
Will you commit to spending 1.5 hours per week during the Quantum Leaps program working on your project?*
Preferred language of correspondence with your mentor:*
If you do not have a preference, please Select All

Demographic Data

We collect demographic information to help us understand the diversity of our participants, ensure our programs are inclusive, and improve our offerings. Your responses will remain confidential and will only be used for reporting and program improvement purposes.
Which of the following gender categories best describes how you self-identify?*
Do you identify with any of the following groups? (Select all that apply)*

Participation and Media Release Consent

The applicant has indicated that they are interested in participating in the Quantum Leaps Program. This program is part of the Society for Canadian Women in Science and Technology’s (SCWIST) Youth Engagement Initiative. Our mission is to encourage girls and young women to pursue their studies in math, science, and technology and to equip them with the necessary tools they need as women in STEM fields! Please indicate your consent to the applicant’s participation and to the use of their name or visual representations (photographs or video recordings) for SCWIST program promotion and impact reporting to our funders and official SCWIST members.
Participation Consent:*
Media Release Consent: I give permission for the Society for Canadian Women in Science and Technology (SCWIST) to use the name or visual representations (photographs or video recordings) of the applicant for the following:*
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Parent/Guardian Name:*
Clear Signature
Please use your mouse (if on a computer) or finger (if on a tablet) to sign in the box.
Clear Signature
Please use your mouse (if on a computer) or finger (if on a tablet) to sign in the box.

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