SAS Peer to Peer Mentorship Application 2019-20

Full Name: *
Student Number: *
Email *
Year and Program of Study: *
To better pair you with a mentor, tell us about your personal interests and hobbies (check all that apply): *

To better pair you with a mentor, tell us about your personal interests and hobbies (check all that apply): Reading Watching movies Music Gaming Sports Fitness Photography Writing Other Other
What do you hope to gain from having a mentor? (check all that apply) *

What do you hope to gain from having a mentor? (check all that apply) Social/friendship Academic Support Community Involvement Other Other
What are some of the goals you hope to achieve this academic year?
Availability

When are you availabile to meet your mentor?
Tuesdays *

Tuesdays 9:00am-9:30am 9:30am-10:30am 11:30am-12:30pm I am not available on Tuesdays
Thursdays (check all that apply) *

Thursdays (check all that apply) 1:00pm-1:30pm 1:30pm-2:30pm 2:30pm-3:30pm 3:30pm-4:30pm I am not available on Tuesdays or Thursdays but can meet:
How often are you hoping to meet with your mentor? *

How often are you hoping to meet with your mentor? Once a week Every other week As needed
In accordance with Student Accessibility Services, I as a mentee in the Mentorship Program, acknowledge that I have made a commitment to the following responsibilities:

1. Will try to attend meetings, workshops and social events and be actively involved.

2. Initiate and maintain contact on an on-going basis (to be mutually agreed upon by both the mentor and the mentee)

3. Report to my counselor of any problems, issues, or concerns that arise.

4. Provide feedback to the mentor to ensure the mentorship program’s continued effectiveness and accessibility.

5. If at any point during the program you wish to opt out, you must contact your counsellor through email, with a detailed explanation as to why you desire to terminate your participation in the mentorship program. *

In accordance with Student Accessibility Services, I as a mentee in the Mentorship Program, acknowledge that I have made a commitment to the following responsibilities:

1. Will try to attend meetings, workshops and social events and be actively involved.

2. Initiate and maintain contact on an on-going basis (to be mutually agreed upon by both the mentor and the mentee)

3. Report to my counselor of any problems, issues, or concerns that arise.

4. Provide feedback to the mentor to ensure the mentorship program’s continued effectiveness and accessibility.

5. If at any point during the program you wish to opt out, you must contact your counsellor through email, with a detailed explanation as to why you desire to terminate your participation in the mentorship program. I authorize the Student Accessibility Services office to disclose the information I have given in this form to my assigned mentor, to give them a better understanding of who I am and what I am looking to achieve throughout the mentorship program. I authorized the Student Accessibility Services office to disclose my contact information (email, phone numbers, etc.) to my mentor for future interactions.
Draw your signature into the box below.

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SAS Peer to Peer Mentorship Application 2019-20

SAS Peer to Peer Mentorship Application 2019-20

Availability