Let's Get to Know You

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Thank you for your interest in the Mental Wellness Mentors program!

You are invited to complete this form to assist with optimizing your experience in the program. Your response will be reviewed by the program supervisors to inform the matching process with your mentor!

If you have any questions, please do not hesitate to reach out to the program supervisors, Taylor Maudlin (TaylorMaudlin@cunet.carleton.ca) and Kofi Sakyi (KofiSakyi@cunet.carleton.ca)

First (and Preferred) Name *

Last Name *

Pronouns

Please refer to the following link to learn more about pronouns and why we are asking for yours: https://www.mypronouns.org/

What are your pronouns? (ex. they/them, she/her, he/him, etc.) *

Are you comfortable with us sharing your pronouns and preferred name with your assigned Mentor? *

Yes - you can share my preferred name and pronouns with my Mentor.

No - please do not share my preferred name and pronouns with my Mentor.

Just my name, but not my preferred name or pronouns.

Just my pronouns. Please do not share my name and preferred name with my Mentor.

If you answered "no" or "just my pronouns" to the previous question, let us know how you would like your name and pronouns to be shared with your mentor (ex. communicated by you, via email, etc.):

Program & Year (e.g.: Aerospace Engineering - 1st Year) *

Where do you call home? *

Are you an international student? *

Yes

What are your hobbies/interests? *

How did you hear about the Mental Wellness Mentors program? *

What are your reasons for joining the Mental Wellness Mentors program? *

Are you currently accessing any other resources on campus? (E.g. Residence Fellows, Residence Managers, Residence Counsellors, FITA Program, Centre for Student Academic Support, physicians through the main Health and Counselling Clinic (CTTC), etc.). If yes, please describe. *

What are you hoping to get out of the Mental Wellness Mentors program? (i.e. expectations and goals) *

How will you know when you have achieved your goals in the program? *

What do you consider to be your greatest strengths? (e.g. patience, organized, friendly, etc.) *

What can your Mentor do to support your circumstances right now? *

Is there anything that you feel is important for us to know in order to optimize your experience in the program? *

Do you have a preference for the gender of your Mentor? *

Yes

If you do have a preference for the gender of your Mentor, please describe:

Can we share your form responses with your assigned Mentor? *

Yes

Thank you! Your responses will be reviewed by the program supervisors (Community Managers Taylor Maudlin and Kofi Sakyi) and you will be contacted shortly to discuss the next steps to your participation in the program!

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