STUDENT VANGUARD APPLICATION FORM - Vanguard Secondary School

Vanguard Intake

Please complete the following Intake Survey and Vanguard Secondary Application as thoughtfully and as best as you can. After Vanguard has received this application, as well as the school-based team referral from your current school, you may expect a call within 2-3 weeks to arrange a Preliminary Interview. As a reminder, all information received is kept in agreement with the Freedom of Information and Protection of Privacy Act.

Name
Email
I would like to be considered for enrollment as of:*
Enrollment into Vanguard is done Quarterly ( September, November, February and April).
YOUR (THE APPLICANT'S) KEY CONTACT INFORMATION:
Legal First Name
Legal Last Name
Preferred Name
Pronouns
Home Address
Postal Code
Phone Number
Parent/Guardian Name
Parent Cell Number
Student Cell Number
Student Date of Birth (dd/mm/yyyy)
Gender
Are you Aboriginal?
- Yes
- No
Current School
Current Grade
Current Courses
Please list the classes you are currently enrolled in.
Why are you applying to Vanguard Secondary?
What support(s) have you accessed in your school?
- School Counselor
- Resource Teacher
- Youth Care Worker
- S.E.A.
- ASW
- Homework Club
- Food Program
- Other
Support can include: programs, people who have directly supported you, technology tools or supportive materials that have been helpful.
Which of the following match with your circumstances?
- Academic Disinterest (bored)
- Chronic Absenteeism/Attendance Problems (skipping)
- Chronic Health/Illness
- Academic Underachievement (Poor Grades)
- School or Community Disengagement (Not participating in any school/community programs)
- Substance Use (vaping/drugs - including marijuana & alcohol)
- Negative relationship with peers.
- Mental Health Support Required
- Learning Disability Support Required
- Physical Disability Support Required
- Just Wanting a Change
- Not sure or None of the Above Apply
- Other
HOW ARE THINGS FOR YOU AT SCHOOL AND IN THE COMMUNITY?
I attend school regularly.
- Yes
- No
I am receiving the academic support I need.
- Yes
- No
When at school, I go to my classes regularly.
- Yes
- No
I am part of a team or club.
- Yes
- No
My favourite class is:
My least favourite class is:
HOW ARE THINGS IN YOUR COMMUNITY AND IN YOUR RELATIONSHIPS?
What do you do for fun?
I have a job.
- Yes
- No
My parents/guardians always let me stay at home over-night, even if they are upset with me.*
- Yes
- No
I always resolve conflicts in non-violent ways.
- Yes
- No
What Community Supports have you accessed?
- CYMH
- Counseling
- Big Brother/Sister
- The Hub
- Hospice
- Social Worker
- Probation Officer
- MCFD
- SPEAK
- START
HOW IS YOUR HEALTH?
Do you have a Family Doctor
- Yes
- No
Do you have a psychiatrist/counselor
- Yes
- No
Do you go to sleep the same time most nights & get at least 7hrs of sleep?
- Yes
- No
I get angry easily.
- Yes
- No
I have had a head injury.
- Yes
- No
I eat well (three meals a day)?
- Yes
- No
I have "intentionally" hurt myself.
- Yes
- No
Do you have any other health concerns?
(allergies, medial conditions, etc...)
WHAT'S IMPACTING YOUR LIFE?
I have been discriminated against.
- Yes
- No
Someone close to me has passed away.
- Yes
- No
I have been impacted by violence or another serious crime.
- Yes
- No
My parents have gone through a divorce or separation.
- Yes
- No
I have lived on the streets for more than a week.
- Yes
- No
I have experienced bullying or harassment.
- Yes
- No
I feel pressures related to my family's cultural background.
- Yes
- No
I have been diagnosed with a physical or mental illness.
- Yes
- No
I have been impacted by a long hospital stay.
- Yes
- No
I am impacted by poverty or financial issues.
- Yes
- No
I am impacted by my own or others addiction.
- Yes
- No
Other things impacting my life, good or bad, are:
I have thought about suicide or attempted suicide.
- Yes
- No
If Yes above, who did you share this with?
Which adults do you/would you talk to about personal things?
Other Important information you would like to share.
FULL PARTICIPATION POLICY - Given that within unhealthy cultures, deception (lying) is an active part of the "enabling" process, we will not endorse or perpetuate any form of deception - to oneself or others. Although this can be challenging, we believe that there are no good "secrets".
Statements or information that potentially put your "safety" or the "safety of others" at risk, may be disclosed to protect the safety of yourself and others.
- Yes, I will fully participate in the program or school and understand that information related to "safety" is disclosed as necessary.
- No, I'd like to withdraw my application for another time or when I'm ready.
PLEASE ENSURE THAT A COPY OF THE STUDENTS LAST REPORT CARD IS SUBMITTED. This is required as part of the application to Vanguard Secondary.

Questions/Fields currently Hidden

What support have you accessed in your school or community?
Support can include: programs, people who have directly supported you, technology tools or supportive materials that have been helpful.
I am usually happy.
- Yes
- No
I choose not to do drugs.
- Yes
- No
I have regrets around previous relationships.
- Yes
- No
I have a role model.
- Yes
- No
All of my friends/relationships are of a similar age (within two years).
- Yes
- No
I like all the people I hang around with.
- Yes
- No
Do you have any additional relationship concerns?
I belong to a team or a club.
- Yes
- No
I go to all my classes everyday.
- Yes
- No
I stay sober at all social events (e.g. school dances, concerts, etc...).
- Yes
- No
I worry about my grades.
- Yes
- No
I would ask for help from school staff (e.g. teacher,counselor, administrator, etc...) if I was worried about another student being harassed, or if I were being harassed.
- Yes
- No
I am passing all my classes.
- Yes
- No
I have viewed and understand the schools/programs website and agree to follow the District Code of Conduct. Intentional, unsafe behaviour will result in withdrawal from Project Resiliency and may affect my application to Vanguard Secondary.
- Yes - I agree
- No - I need further information
I will remain on the property of Project Resiliency/Vanguard Secondary until dismissal at the end of the day. Lunch will be available at no cost. I understand that I am responsible for my own transportation to and from Project Resiliency and Vanguard Secondary.
- Yes, I understand

Vanguard Intake

YOUR (THE APPLICANT'S) KEY CONTACT INFORMATION:

HOW ARE THINGS FOR YOU AT SCHOOL AND IN THE COMMUNITY?

HOW ARE THINGS IN YOUR COMMUNITY AND IN YOUR RELATIONSHIPS?

HOW IS YOUR HEALTH?

WHAT'S IMPACTING YOUR LIFE?

FULL PARTICIPATION POLICY - Given that within unhealthy cultures, deception (lying) is an active part of the "enabling" process, we will not endorse or perpetuate any form of deception - to oneself or others. Although this can be challenging, we believe that there are no good "secrets".

PLEASE ENSURE THAT A COPY OF THE STUDENTS LAST REPORT CARD IS SUBMITTED. This is required as part of the application to Vanguard Secondary.

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