UTMSU Peer Support Registration Form

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Hi there! We're happy to hear that you're interested in accessing the University of Toronto Mississauga Students' Union (UTMSU) Peer Support program. The program is now open for appointments! Please fill out the form below to register for an appointment and you will be matched with the Peer Support Volunteer who would be the best fit for you based on your needs.

To ensure that we are able to help you in the best way possible, we will need to collect some information from you. This also helps us understand who is accessing our service and how we might be able to better tailor them in the future.

An email will be sent out to notify you once appointments open up and you will be able to book one based on your availability.

***Note: The Peer Support Program is not a crisis service.***

If you have any questions, concerns or require any assistance please email peer@utmsu.ca or president@utmsu.ca.

First and Last Name *

Preferred Name (optional)

Pronouns *

They/Them

She/Her

He/Him

Xi/Xer

Other:

Required

Phone Number *

Email Address (this will be used to confirm your appointment) *

Do you consent to us following up with you via email in order to gain feedback about your experience with the Peer Support Program? *

Yes

Age (we collect this information as a means of understanding who is choosing to access our Peer Support services, and so that - when possible - we can match you with a Peer Support volunteer who is of a similar age) *

YYYY

Which population best describes you? *

Indigenous

Black or African American

Hispanic or Latin American

Caucasian or White

Middle Eastern or Arab

South Asian (e.g. East Indian, Pakistani, Sri Lankan, etc.)

West Asian (e.g. Iranian, Afghan, etc.)

East Asian (e.g. China, Japan, ect.)

Other:

What is your current status as a UTM student? *

Full-time Student

Part-time Student

Mississauga Academy of Medicine (MAM) Student

Program of Study *

Please list all of the days and times between Monday - Friday 10AM - 6PM that you are available for an in-person appointment. This will help us schedule your appointment.

(example: Monday 2-3PM , Tuesday 11AM - 4PM, Friday 1-3PM)

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