Achievement In Motion (A.I.M.) Mentorship Program Application Form

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Thank you for confirming your interest in wanting to learn more about the program. The information contained on the completed form is confidential and will not be shared with any persons other than the Mentorship Committee.

We request that you complete this form as fully as possible.The information you provide will help us to match you with a mentee that is looking to refine their skills, capacities, and competencies in ways that best meets your area(s) of expertise.

Do you give consent to having the information provided in this form used in forming mentor-mentee pairs? *

Yes

Contact Details

First Name *

Last Name *

Email *

Phone Number *

City *

Mentoring Information

Mentor Participation in the program is from September to April. The amount of time you commit to the program is to be determined by you and your mentee; however, we suggest that you connect with your mentee at least once a month through a channel agreed upon between the two of you (in-person, Zoom, Google Meets). Are you prepared (and have capacity) to commit a minimum of one hour per month to this 8 month program (per mentee)? *

Yes

Please select the reason(s) for wanting to be a mentor: *

Personal and Career Development

Leadership and/or skills development

Building and/or maintaining professional networks

Develop a community of learning

Reinforce learning and development by sharing knowledge and skills

Other:

Required

Please identify your areas of expertise, knowledge and/or experience that you can mentor on: *

Please tell us a bit more about yourself to help us pair you with an appropriate mentee(s). *

What do you hope to gain by being part of the A.I.M. mentorship program? *

How many mentees would you be willing to mentor during the 8-month program? *

Do you have any specific preferences in terms of the level of mentee you would like to mentor? *

We will take your preferences into consideration when matching, though it may not be possible to meet all your preferences.

Yes

Other:

General comments that you feel are important for us to know *

Have you mentored a mentee before – formally or informally? *

Yes (formally)

Yes (informally)

If you answered yes to the previous question, may you please indicate in what area the mentorship focused on? *

Mentoring Contact preferences

Please indicate how you would prefer to meet with your mentee? *

Video Conferencing (Zoom, Google Meets, etc.)

In-person meets

Phone

How often would you be prepared to have contact with your mentee? *

Once a week

Once a month

Twice a month

Bi-monthly

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