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Inscription BECOME 2019-2020
OTHER INTERNSHIPS COMING SOON
JANUARY, FEBRUARY & MARCH
2020
In collaboration with :
REGISTRATION DEADLINE December 20, 2019
INTERNSHIPS OFFERS
For French-speaking, English-speaking and Bilingual students
Accommodations, transportation and meals provided
Inscription BECOME 2019-2020 2
INTERNSHIP DESCRIPTION
In collaboration with the CBC, we are giving you the opportunity to experience a two-day individualized
shadowing internship among the occupations identified on the following page.
We will try to pair you with a station near you, either Montreal, Quebec, Sept-Îles (radio only), Rouyn-
Noranda, Trois-Rivières or Chicoutimi.
If you are selected, the internship start date will be determined based on your availability and that of the
CBC and if you are selected.
Internships will take place in January, February and March 2020.
THIS INTERNSHIP IS MADE POSSIBLE WITH :
Inscription BECOME 2019-2020 3
Dive into the reality of the media world while enjoying an exciting experience!
A great opportunity to get to know various occupations in the world of media!
OCCUPATION AT CBC
Check two occupations of interest that you would like to know more about.
Journalist Broadcasting service engineer
Cameraman Web content developer
Editor Control room operator
Sound technician Switcher
Stage technician Producer
Researcher Web content manager
Graphiste designer Off production : Accounting, Human Resources and communications
Is there a city, other than the one near you, where you would like to do your internship?
Montréal Québec Chicoutimi Trois-Rivières Rouyn-Noranda
Sept-Îles (radio only) Why? __________________________________________
What languages do you speak?
French English French and English (Bilingual)
What dates are you available ? (enter 3 choices of dates please)
_____________________________ _____________________________ __________________________
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ABOUT YOU
We would like to know more about your connection with technology and media.
Check all the answers that relate to you.
How often do you use the INTERNET?
Rarely A few times a day Several times a day
Why do you navigate the INTERNET?
School News Sports Video games
Movies Online shipping Social Media
Which applications do you use the most frequently?
__________________________________________________________________
__________________________________________________________________
How often do you watch TELEVISION?
Rarely A few times a day Several times a day
How often do you listen to the RADIO?
Rarely A few times a day Several times a day
How often do you read NEWSPAPERS?
Rarely A few times a day Several times a day
SHARE YOUR THOUGHTS!
In a few words, tell us why you would like to participate in the BECOME program in Radio-Canada?
Inscription BECOME 2019-2020 5
REGISTRATION FORM (TO BE COMPLETED BY THE PARENT OR THE LEGAL GUARDIAN)
RADIODIFFUSION AND MEDIA PRODUCTION INTERNSHIP JANUARY, FEBRUARY AND MARCH 2020
PARTICIPANT OF THE BECOME PROGRAM
Name
F M Other Date of birth
Name of school Grade Level 3 4 5
Address
City Postal Code
Province Phone number
BILAN DE SANTÉ BILAN DE SANTÉ BILAN DE SANTÉ BILAN DE SANTÉ
HEALTH INFORMATION
Health Insurance Number Expiration date
Does your child have dietary restrictions? Yes No
Explain :
Does your child have any allergies? Yes No
Explain:
In case of an allergic reaction, does caring for your child require any specific interventions?
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CONTACT PERSON IN CASE OF EMERGENCY
Name
Relation to youth
Phone / Cell phone
DESIGNATION OF PARENTAL AUTHORITY
Person accompanying the
youth during the activity Relation to youth
Name of parent or
legal guardian
Phone / Cell phone
Signature
TRANSFER OF RIGHTS
I hereby agree that my child can be filmed, photographed or interviewed to promote the New Pathways Foundation in the context
of an advertising campaign or other events or activities.
Therefore, in my name and on behalf of _______________________________________, I transfer all the rights that we could
have, under the previous paragraph, to the New Pathways Foundation and CBC.
I acknowledge that this transfer of rights in favour of the Foundation is being made without compensation and I hereby grant a
complete waiver of these rights.
Signed in (City) Date
Signature (Parent or Legal Guardian )
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Please return the duly completed application before :
December 20, 2019
by email or by regular mail to the following address:
250, Place Chef Michel Laveau, local 102
Phone: 418-843-4173
Email: [email protected]
Website: nouveauxsentiers.com/en/
For more informations please contact : Mélanie Roy, Project Manager at 418-806-1711
