Name:
Age:
Email:
Phone #:
Address:
City:
Province:
Postal Code:
Current school attending:
Post secondary institute (current or proposed):

Odyssey of the Mind Participation List (Please list most recent participation first and if more room is needed please use the back of this form):
Year                Problem and School
-
-
-
-
-
List any awards won while participating in Odyssey of the Mind:

Name of your most recent Odyssey of the Mind Coach:
Phone #:

Other extra curricular activities (Please list your most important only, maximum 5):
Year                Activity
-
-
-
-
-

Fill out this form and it with a letter of recommendation and a creative item to: CPSS at P.O. Box 18101 RPO Heritage Mtn., Port Moody, BC V3H 0A2