Discovery Week Community Participation Form

Fields denoted by an asterisk (*) are required.

Coordinator's Name Coordinator's Name First Last
Coordinator's Email Address
Coordinator's Phone Number Coordinator's Phone Number - ### - ### ####
Organization and Community
Discovery Week Information

Number Students During Discovery Week: (choose a number in one week or both weeks)

Students will check into their accommodations on the Sunday and report to the community coordinator on Monday at 0800hrs. They will depart the community after all scheduling on Thursday evening.
Week 1 (May 26 - May 29, 2025)
Week 2 (June 2 - June 5, 2025)
Accommodation Information

Students will be instructed to check into their accommodations the day prior to
starting their Discovery Week.
Accommodation
Contact for Accommodation
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone Phone - ### - ### ####
Email
Is there a hospital discount rate that you are aware of?
Rooms reserved by

Rooms reserved by Community Schulich
The number of rooms required will be based on the number of learners in the community. Please use the box below to provide any additional accommodation information.
We can issue payment from Western University either by invoice or by VISA. Please let me know if we are able to arrange for payment by VISA with the manager/owner of the accommodation. (Please choose one)

We can issue payment from Western University either by invoice or by VISA. Please let me know if we are able to arrange for payment by VISA with the manager/owner of the accommodation. (Please choose one) Yes payment can be made by VISA. The manager/owner will provide an invoice for payment.
Will your community require the medical students to make a presentation to the students at your local high school during Discovery Week?

Will your community require the medical students to make a presentation to the students at your local high school during Discovery Week? Yes No
Other important information

Discovery Week Community Participation Form

Discovery Week Community Participation Form

Discovery Week Information

Accommodation Information