Co-op Mentoring Mentor Application

This Form Will Take You Roughly 15-20 Minutes To Complete

In order to keep the information private and secure this application must be completed all at once and cannot be saved in stages. Please make sure you have enough time before starting the application. Thank you!

Please note that the information provided in this application will be held strictly confidential. PLEASE ENSURE THE APPLICATION IS COMPLETED IN FULL.

How did you hear about our agency?(Required)

PERSONAL INFORMATION

Name(Required)

First Last

Preferred Name (if applicable)

Gender Identity(Required)

Pronouns

Address(Required)

Street Address Address Line 2 City Province Postal Code

Phone(Required)

Email(Required)

Date of Birth(Required)

School Name(Required)

Grade(Required)

Tell us about yourself. Why are you interested in applying to become a Co-op Mentor?(Required)

What day of the week are you available to mentor?(Required)

What time of day are you available to mentor?(Required)

Parent/Guardian Information

Please provide us with the name and contact information of your primary caregiver.

Parent/Guardian Name(Required)

First and Last

Relation to Child(Required)

Mother

Father

Other

Parent/Guardian's Phone Number(Required)

Parent/Guardian's Email Address(Required)

Before continuing, please ensure that your references know you have applied and ask them to watch for a reference email from our Agency. Also, please ensure that the email addresses of your references are spelled correctly below. Moving to the next steps in the enrolment process is contingent upon the completion of your references.

PERSONAL REFERENCE

Examples include a friend, family friend, coworker, etc. Must have known you for at least 2 years and be 18+

Personal Reference Full Name(Required)

Personal Reference Email(Required)

Personal Reference Phone(Required)

How long have you known your Personal Reference?(Required)

In what capacity do you know your Personal Reference?(Required)

TEACHER REFERENCE

Please provide a reference from your current or past teacher. Must be 18+

Teacher Reference Full Name(Required)

Teacher Reference Email(Required)

Teacher Reference Phone(Required)

How long have you known your Teacher Reference?(Required)

In what capacity do you know your Teacher Reference?(Required)

FAMILY REFERENCE

Examples include parent/guardian, sibling, aunt, etc. Must have known you for at least 2 years and be 18+

Family Reference Full Name(Required)

Family Reference Email(Required)

Family Reference Phone(Required)

How long have you known your Family Reference?(Required)

In what capacity do you know your Family Reference?(Required)

REFERENCE PAGE ATTESTATION

I hereby confirm that I am the individual for whom this application is being made. I further attest that the information provided here is true and complete to the best of my knowledge.(Required)

Yes

No

Applicant Signature(Required)

OPTIONAL SECTION: STATISTICAL INFORMATION

At Big Brothers Big Sisters of Peel York, statistical information is requested from volunteers and families for the purpose of better understanding the community in which we serve, and for acquiring funding from community supporters and donors. This allows us to provide culturally responsive and high-quality services at no cost.

Please note: Filling out this form is optional. If you choose to complete it, the information you provide below will be kept confidential and will in no way affect your eligibility to participate in our program(s).

Language(s) spoken

Birth Place

Canada

Other

If you were born outside of Canada, please provide the year you moved to Canada.

Please select the ethnic/cultural origin that you feel best describes you or use the next field to enter it directly.

If none of the options above accurately reflect your identity, please feel free to add a note here:

Phone

This field is for validation purposes and should be left unchanged.

Co-op Mentoring Mentor Application