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SCWIST TELEMENTOR APPLICATION FORM


Thank you for your interest in the Telementoring Program.
We are now taking applications for the 2005 session.

(please note: you will need to supply names of references at the bottom of this form)

Name: 

Address: 

City:     Province:      Postal Code: 

Tel(day):      Tel(eve):      Fax:

Email: 

Occupation:

Company Name:

Work Address:

City:     Province:     Postal Code:

Check the categories into which your occupation falls:

Biology                          Chemistry             Medicine           Physics     

Computer Science          Engineering           Trades              Technical 

Briefly describe your duties and responsibilities at work:

Outline your educational background and/or previous work experience:

List your current interests or hobbies:

Describe any experience you have had working with young people:

List any other volunteer work you are involved in:

Why are you interested in being a mentor?

Please provide two references (professional or personal) that we may contact:

1. Name:       Tel:  

    Relationship: 

2. Name:       Tel:  

    Relationship: 

If I am matched with a mentee/protégée, I promise to do the following:

  • E-mail twice a week for 5 to 6 months
  • Provide guidance and respond to questions whenever possible
  • Evaluate experience
  • Participate in any mentor training that may be scheduled

By clicking "Submit Form" below, you are agreeing to the above conditions.

  

Please note: Telementoring sessions begin in January each year. We accept applications for mentors at any time, however, depending on the date, you may not be matched until the next Telementoring session.