2024 Fighting Blindness Canada Mentorship Program: Mentor Application

Thank you for your interest in the Young Leaders Mentorship Program! Please complete the below application no later than January 31, 2024.

Sign in to Google to save your progress. Learn more
MENTOR INFORMATION
Name *
Birthdate *
MM
/
DD
/
YYYY
Address *
City *
Province *
Postal Code *
Phone Number *
Email *
Gender
Preferred Pronouns  *
What is the name of your eye condition? *
Do you have any accessibility requirements? 
COMMUNICATION STYLE
What is your preferred method of communication? (please select a maximum of three): *
Required
EDUCATION & EMPLOYMENT EXPERIENCE
Please provide a brief overview of your educational background *

If you are employed, what is your position and where do you work?

 *

Do you have any experience mentoring or being mentored?

 *
AVAILABILITY

Do you have access to the internet and a computer?

 *

Are you able to commit to eight 1-hour sessions and one 3-hour workshop with your mentor between February and October 2024? (All sessions will take place virtually). 

 *
SHORT-ANSWER QUESTIONS

(Please limit each answer to 200 words or less)

What attracted you to the Young Leaders Mentorship Program?

 *

Describe a time when you had to help someone through a difficult situation. What did you learn from the experience?

 *
How would you handle working with someone who is resistant to your advice or guidance?
 *

In what subjects do you feel you can provide insight and guidance to your mentee? (Please select all that apply)

 *
Required
If other, please specify

Is there anything else you would like us to know?

 *
THANK YOU

Thank you for taking the time to fill out this application! We will be accepting 15 mentee/mentor pairs into the program in 2024. Please note that we do our absolute best to match all candidates who apply but we cannot guarantee a match.  We will be in touch by late February 2024 with an update on your application.

Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms