Mentee Matching Form

Mentor Mentee Matching Form
Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Race or Ethnicity
Gender
Language Proficiencies
Address City Province
Email address Phone
Your Hobbies and Interests

Visual ArtsElectronic GamesFilm TravelMusicVolunteeringPoliticsReading (Fantasy/Fiction)SportsLiterary WorksOther
What Best Describes you

OutgoingBusiness-orientedConstructiveEmpatheticFunnyLivelyIntuitivePassionateReservedReflectiveVibrantOther
Professional Interest or Expertise

Arts and EntertainmentEducationEngineeringFinancial ServicesHealth Care and MedicineInformation TechnologyMarketing and AdvertisingPoliticsScience and TechnologyRetail & fashionStudentOther
The role you would like your Mentor would take part

ColleagueNurturerListenerTeacherMotivatorCareer DevelopmentLife CoachIndustry CoachOther
Which areas of life are you currently seeking the most guidance in? (Select up to three options)

Communication Skills ImprovementSelf esteem & DevelopementNavigating mental health and well-beingEnhancing cultural or community connectionsBalancing academics or work with personal lifeManaging stress and building resilienceOther
Will this be your first time participating in a mentoring program?

YesNo
Your Preference of Communication with your Mentor

emailchattextphonein-person (might take longer to get paired)Other
Your Preferred Mentor

MaleFemale
How did you hear about us?

Social mediaWebsiteThrough a friendReferral from community agency ( please specify)Other
Will you be interested in joining our virtual support groups and programmes when available?

YESNOOther
Your Personal Information
Tell us something about yourself
Do you have any religious/personal beliefs, and if so, would you prefer to be paired with a mentor who shares those beliefs?
What are your expectations in this Mentoring program
What are your long and short term goals
What challenges are you currently facing?
Date

MonthDayYear
Date
Should be Empty:

Mentor Mentee Matching Form

Your Personal Information