New Protégé Sign Up Form

As you are under the age of 18, your parents or guardian will be contacted in order to provide consent for your participation in this initiative.

Please include your parent’s or guardian’s name and contact information

Thank you for providing this information.

First Name

Last Name

Email Address

Phone Number

We would like to learn more about you to help us find you a great match!

Participant Information

First Name

Last Name

To which gender identity do you most identify? (optional)
WomanManNon-binaryTransgenderGenderqueerTwo-spiritPrefer not to answer

City

Province or Territory
---AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon

Postal Code

Email Address

Phone Number

I do not have an email or phone number

Name of the employment service you are presently or most recently connected to:

I am or was connected to:

I am not connected with a service provider, but would like to be.

Mentoring Experience

What jobs or careers are you interested in?

What would you like to do during your mentoring experience (click on all those that apply).

Understanding more about the mentor’s job and career pathWork-site tour and meeting with employeesJob shadowing with an existing employeeHands-on experience supervised by an existing employeeMeeting with an HR Professional

Anything else you would like to share that would help us find a good mentoring experience for
you?

Do you have any work experience?
YesNo

What is your highest level of education?
High-school or lessCollege and/or TradeUniversity

Other:

How would you like to connect with a mentor? Please click on all that apply:
Online, virtual mentoring experienceIn-person, onsite mentoring experience

Providing Feedback

Once you have met with your mentor, we would like to hear from you. This helps us to improve
how we do things.
I understand that feedback is important and I am willing to participate.I am not comfortable providing feedback.

Please tell us the best way to get your feedback: (select all that apply)
By telephoneOnline surveyBy email survey

Other:

Sharing Stories

Once you have completed a successful mentoring match, we would like to share your story so that others can benefit as well. The MentorAbIlity Canada initiative is committed to the respectful portrayal of all participants in the mentoring experience.

If you are not comfortable sharing your story, we respect your wishes. This will not affect your participation in MentorAbility. And even if you provide permission, you can change your mind at any time.

I give permission to MentorAbility Canada to share my story. They can use information about me. This includes photos, videos and quotes. They can use this information to promote and document the project.I am not comfortable sharing my story.

I am only comfortable with portions of my story being shared:

Receiving Information

I would like to receive information from the Canadian Association for Supported Employment.
Information includes emails, event invitations, newsletters, and announcements. I understand that I
can unsubscribe at any time.
YesNo

Additional Information:

How did you learn about MentorAbility Canada?
---Supported employment service providerWebsiteSocial Media (LinkedIn, Facebook, Instagram, Twitter)Friend/colleague

Other:

MentorAbility Canada follows good safety and security standards. In addition, general liability coverage is provided for all MentorAbility Canada Project protégés during their mentoring experiences.