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2023-2024
Black Students Mentorship Program (BSMP)
Mentor Application form
| York University
Should you have any questions, please contact the team at:
bsmp.health.yu@gmail.com
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* Indicates required question
First name
*
Your answer
Last name
*
Your answer
Preferred email address
*
Your answer
How do you identify? (Select all that apply)
*
African
African-Canadian
Bi-racial/Multiracial
Black
Caribbean Black
Indigenous Black
Non-Black Racialized (or POC)
Non-POC ally
Other:
Required
What level of studies have you completed?
(This will help us match mentors/mentees appropriately)
*
Undergrad (3rd year)
Undergrad (4th + year)
Graduate - Masters
Graduate - Doctoral
Post-Doctoral
Professional
Other:
Required
What is your area of study or profession? Please indicate your title and area of specialization.
*
Your answer
What program or area of study are you able to mentor? Please select all that apply
*
Psychology
Global Health
Neuroscience
Nursing
Kinesiology & Health Sciences
Health Studies (Policy, Management, Informatics)
Required
Do you have mentoring experience? If yes, please briefly describe this experience. For e.g.: What was the context? How do you feel about your experience? What was the structure of the program(s) you were a part of?
*
Your answer
What motivates you to be a mentor for the Black Student Mentorship Program
*
Your answer
Are you able to commit to mentoring sessions at least twice a month, for at least 1 hour each?
*
Yes
No
Maybe
If you answered 'maybe' to the previous question: could you please elaborate?
Your answer
Would you be open to also contributing in other programing we may offer through the year?
*
Yes, I could run a workshop
Yes, I could participate in a career or academic panels
Yes, I have other ideas I would like to share
I would only be available to mentor
Other:
Required
Please indicate your preferred method(s) of communication with your prospective mentee/s (select all that apply).
In person
Phone
Email
Zoom or other video conferencing technology
Other:
Please indicate your preferred blocks of time for potential mentorship scheduling. We will do our best to include preferences in matching you with mentees
Daytime during the week
Evening during the week
Other:
Clear selection
Thank you for filling out this form. It means a lot to us that you want to support this program and Black students navigating academia. Please feel free to share any thoughts, comments or feedback you may want to add below. We will be in touch soon.
Your answer
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