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7/13/13 Student Mentor/Mentee Application

https://ss.cf.ryerson.ca/trimentoring//studentProfile.cfm 1/4
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Tri-Mentoring Program
Student Mentor/Mentee Application
Fields marked with an asterisk (*) are required.
Applicant Information
The Tri -Mentori ng Program i s commi tted to respecti ng the personal pri vacy of i ndi vi dual s and al l personal
i nformati on you provi de i s protected under the federal Pri vacy Act. The Tri -Mentori ng Program wi l l not use or
di scl ose personal i nformati on for purposes other than those for whi ch i t was col l ected, except wi th the consent of
the i ndi vi dual . The Tri -Mentori ng Program wi l l reserve the ri ght to retai n personal i nformati on onl y as l ong as
necessary for the ful fi l l ment of i ts purposes and i n accordance wi th retenti on gui del i nes or regul atory
requi rements. If you have questi ons about the col l ecti on, use, and di scl osure of thi s i nformati on by the Uni versi ty
pl ease contact the Coordi nator of Tri -Mentori ng Program at 416-979-5000 ext.7988
* Title * First Name * Last Name
* Apply to be:
Student Mentee Student Mentor
* Student Number:
Name at Graduation: (if dif f erent)
* Projected Graduation Year:
* Program:
* Current Program Year: 1st 2nd 3rd 4th Other:
Home Address
* Address:
* City:
* Province:
* Postal Code:
* Country:

Contact Information
* Home Phone:
Cell Phone:
Work Phone:
Mailing Address (same as address )
Address:
City:
Province:
Postal Code:
Country:


Fax Number:
* Ryerson
Email:
@ryerson.ca
Other Email:

Personal Information
Do you prefer to be matched with a student who is
Quiet
Outgoing
Doesn't Matter
7/13/13 Student Mentor/Mentee Application
https://ss.cf.ryerson.ca/trimentoring//studentProfile.cfm 2/4
Are you currently working?
Yes
No
On average, what is your availability?
Days
Evenings
Weekends
Do you live in residence?
Yes
No
Preferred method of communication with your partner:
In Person
Phone
Email
Do you prefer to be matched with a
Male
Female
Doesn't Matter

Mentoring Goals
Why would you like to participate in this program?
Establish three goals you would like to achieve through mentoring
Identify the most important role of a mentor
Friend
Advisor
Guide
Check three key elements you would like to see in your partner:
Same Program/Faculty
Pref erred the same method of communication
Similar linguistic/cultural background
Active on Campus
Other:
What qualities would you like to bring to mentoring?

Background Information
What are your career goals?
Comments
7/13/13 Student Mentor/Mentee Application
https://ss.cf.ryerson.ca/trimentoring//studentProfile.cfm 3/4
Do you have any additional information?
How did you find out about the Tri-Mentoring program?

Optional Information
The Tri-Mentoring Program is committed to protecting your privacy. Tri-Mentoring collects and uses your
personal information to operate and deliver services you have requested.
*Please indicate what level of education your parents/guardian completed:
Secondary School
Some college
Some university
College Diploma
University degree
Not Applicable
Other please specif y:
What is your academic status?
Is English your first language?
Yes
No
What is your mother tongue?
Other spoken languages (select up to 3):
1
2
3
What is your Citizenship Status?
Permanent Resident, Lended Imigrant
International Student
Canadian Citizen
Ref ugee
How long have you been in Canada?
Less then 10 years
10 years or more
Are you from racialized group (non-white or non-aboriginal)?
Yes
No
What racial, national or cultural group do you identify with (select up to 4)?
1
2
3
7/13/13 Student Mentor/Mentee Application
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What is your country of origin?
What cultural or religious organizations do you belong to?
Student Involvement on Campus
Please list campus groups or activities you are involved with as a student, i.e., athletic teams, campus
residence, clubs, students politics, etc.
Are you an Aboriginal (e.g., a member of the Indian, Inuit, or Metis peoples of Canada)?
Yes
No
Are you a person with disability (having a persistent physical, mental, psychiatric, sensory or
learning impairment)?
Yes
No
Are you Direct Entry student?
Yes
No
Are you a mature student?
Yes
No
Submit Application
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