GSLP - Student Friend Referral - STEM Leadership

Student Name

First

Last

Student Grade

Student Age

School Name

STEM Canada Advisor

City and Province

Phone Number

Email

Please enter your email, so we can follow up with you.

I am:

An existing leadership student
A new leadership student
I have not yet applied
Other

If other, please specify

Referral 1: Would you like to refer a friend? If so, please provide an email address.

Referral 2:

Referral 3:

Referral 4:

Referral 5:

I heard about this program:

* If you were referred, or hear about the program online, please specify the source and name of org

Referral / Source

I would like additional information on online STEM Immersion Supplement Programs

Yes
No

Thank you for your referral. As a thank you, we would like to enter you into a draw to win 1 year free enrollment to the STEM Canada Medical Science Program (for ages 8-17), and other fun STEM goodies! If you would like to enter, please enter your email address below.

GSLP – Student Friend Referral