Where did you receive your post-secondary education? *
Your answer
What is your level of education *
Required
Are you a professional in a health-related field? If yes, please type in your title/profession. *
Your answer
What program / area of study are you able to mentor? Please select all that apply *
Required
If you selected OTHER, please elaborate on your selection in the space provided below
Your answer
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?(250 words maximum) *
Your answer
In a few words: Why would you like to become a mentor for the Black Student Mentorship Program (250 words maximum) *
Your answer
Are you able to commit to mentoring sessions in the evenings at least twice a month, for at least 1 hour each? (2022-2023) *
Would you be open to and able/prefer to contribute in other ways? *
Required
How did you hear about us? *
Your answer
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.