Please complete the form below, and we'll do our best to match you with a compatible peer mentor. Please share only the information you are comfortable providing.
Personal Information
First Name: Last Name:
Student ID: School: Program: Semester: Home Phone: Cell Phone: Gender:
Campus:
Email:
Do you identify as any of the following? (Check all that apply): Direct from high school
Mature Student (22+)
First Generation (ie: first in your family to attend college) International Student (22+) Aboriginal Student Second Career Student Student with a Disability Helping Youth Pursue Education (HYPE) Graduate Woman in a Non-Traditional Career (Transportation, Engineering, etc.) How do you identify yourself with respect to culture, heritage and/or ethnic background? Canadian (English) Canadian (French)
Aboriginal
American
Latin/South American Caribbean Middle Eastern (Israel, Lebanon, Kuwait and others)
North African (Algeria, Egypt, Libya, Tunisia and others)
Sub-Saharan African (Mali, South African, Nigeria, Senegal and others)
European (Italy, France, United Kingdom, Poland and others)
Oceania (Australia. new Zealand, Pacific Islands and others)
South Asian (India, Pakistan, Bangladesh, Sri Lanka and others)
Chinese
Filipino
South East Asian (Japan, Korea, Vietnam, Thailand and others)
Other: Please Specify
Questionnaire
1. I prefer to be matched with a peer mentor who is:
2. I prefer to be matched with a peer mentor who is:
3. I prefer to be matched with a peer mentor who is:
4. What is your primary reason for seeking a mentor?
5. Check all elements you would like to see in your mentor:
6. What is your preferred language(s) of communication?
7. List any campus activities, extra-curricular programs or organizations you belong to:
8. List any campus hobbies or interests you have:
9. Please provide any additional information you would like us to have:
Please note:
