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7/13/13 Student Mentor/Mentee Application

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Tri-Mentoring Program

Student Mentor/Mentee Application

Fields marked w ith an asterisk (*) are required.

Applicant Information

The Tri-Mentoring Program is committed to respecting the personal privacy of individu als and all personal

information you provide is protected under the federal Privacy Act. The Tri-Mentoring Program will not use or

disclose personal information for purposes other than those for which it was collected, except with the consent of

the indi vidual. T he Tri-Mentoring Program will reserve the right to retain personal i nformation onl y as long as

necessary for the fulfil lment of its purposes and in accordance with retention gui deli nes or regulatory

requirements. If you have questions about the coll ection, use, and d isclosure of this information b y the University

please contact the Coordinator of Tri-Mentoring Program at 416-979-5000 ext.7988

* Title * First Name * Last Name

*Apply to be: Student Me ntee Student Mentor

* Student Number:

Name at Graduation: (if different)

* Projected Graduation Year:

* Program:

* Current Program Year: 1st 2nd 3rd 4th Other:

Home Address

*Address:

*City:

*Province:

*Postal Code:

*Country:

Contact Information

*Home Phone:

Cell Phone:

Work Phone:

Mailing Address( same as address )

Address:

City:

Province:

Postal Code:

Country:

Fax Number:

*Ryerson

Email:@ryerson.ca

Other Email:

Personal Information

Do you prefer to be matched w ith a student who is

Quiet

Outgoing

Doesn't Matter

http://www.ryerson.ca/index.htmlhttp://www.ryerson.ca/index.htmlhttps://ss.cf.ryerson.ca/trimentoring//studentProfile.cfm#https://www.my.ryerson.ca/webapps/login/https://ss.cf.ryerson.ca/trimentoring/login/login.cfmhttps://ss.cf.ryerson.ca/trimentoring/calendar.cfmhttp://www.ryerson.ca/studentservices/trimentoring/index.htmlhttp://www.ryerson.ca/contact/http://www.ryerson.ca/hr/careers/http://www.ryerson.ca/tour/campus.htmlhttp://www.ryerson.ca/studentservices/http://www.ryerson.ca/library/http://www.ryerson.ca/map/http://www.ryerson.ca/news/http://www.ryerson.ca/org/https://www.my.ryerson.ca/webapps/login/https://ss.cf.ryerson.ca/trimentoring//studentProfile.cfm#https://ss.cf.ryerson.ca/trimentoring//SiteIndex.htmlhttp://www.ryerson.ca/index.htmlhttp://www.ryerson.ca/index.html

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7/13/13 Student Mentor/Mentee Application

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Are you currently working?

Yes

No

On average, w hat is your availability?

Days

Evenings

Weekends

Do you live in r es idence?Yes

No

Preferred method of communication with your partner:

In Person

Phone

Email

Do you prefer to be matched w ith a

Male

Female

Doesn't Matter

Mentoring Goals

Why would you like to participate in this program?

Establish three goals you would like to achieve through me ntoring

Identify the most important role of a mentor

Friend

Advisor

Guide

Check three ke y elements you w ould like to s ee in your partner:

Same Program/Faculty

Preferred the same method of communication

Similar linguistic/cultural background

Active on Campus

Other:

What qualities w ould you like to bring to m entoring?

Background Information

What are your career goals?

Comments

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Do you have any additional inform ation?

How did you find out about the Tri-Mentor ing program?

Optional Information

The Tri-Mentoring Program is committed to protecting your privacy. Tri-Mentoring collects and uses your

personal information to operate and deliv er serv ices you have requested.

*Please indicate what level of education your parents /guardian completed:

Secondary School

Some college

Some university

College Diploma

University degree

Not Applicable

Other please specify :

What is your academ ic status?

Is English your first language?

Yes

No

What is your mother tongue?

Other spoke n languages (select up to 3):

1

2

3

What is your Citizenship Status?

Permanent Resident, Lended Imigrant

International Student

Canadian Citizen

Refugee

How long have you been in Canada?

Less then 10 years

10 years or more

Are you from racialized group (non-w hite or non-aboriginal)?

Yes

No

What racial, national or cultural group do you identify with (select up to 4)?

1

2

3

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What is your country of origin?

What cultural or re ligious organizations do you belong to?

Student Involvement on Campus

Please list campus groups or activities you are involved w ith as a student, i.e., athletic teams, campus

residence, clubs, students politics, etc.

Are you an Aboriginal (e.g., a mem ber of the Indian, Inuit, or Metis pe oples of Canada)?

Yes

No

Are you a pers on w ith disability (having a per sistent physical, me ntal, psychiatric, sensor y or

learning impairment)?Yes

No

Are you Direct Entry stude nt?

Yes

No

Are you a mature student?

Yes

No

Submit Application

Ryerson University Web Policy Privacy Policy

http://www.ryerson.ca/privacy/http://www.ryerson.ca/ryerson.ca/webpolicy.html