RISE Program Intake & Participation Form

R.I.S.E PROGRAM

Refining Hope. Igniting Purpose. Strengthening Futures
Description
This form helps us understand each participants goals, strengths, and areas where support may be needed so we can provide the best possible mentorship and learning experience.
MentorMentee
SECTION 1 Participant Information
Full Name*

First NameLast Name
Date of Birth*
Age*
FemaleMaleNon-binaryPrefer not to sayOther
School / Institution Name*
Grade Level (if applicable)
City / Community*
Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Preferred Name (if different)
Primary Language Spoken*
Additional Languages
SECTION 2 Parent / Guardian Information (If Participant Under 18)
Parent / Guardian Full Name*

First NameLast Name
Relationship to Participant*
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email Address*
example@example.com
Home Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
SECTION 3 Participant Background
IndigenousBlack / African descentRacialized youthNewcomer / Immigrant youthRefugee youthYouth living in low-income householdYouth in care / foster systemNone of the abovePrefer not to sayOther
SECTION 4 Education & Career Interests
Graduate high schoolAttend college / universityEnter skilled tradesStart a businessUnsure / exploring options
Business / EntrepreneurshipTechnologyHealth CareSkilled TradesArts / Creative industriesCommunity leadershipPublic service
MathScienceEnglish / Language ArtsSocial StudiesArtsTechnology
Homework / academic successStudy habitsLeadership skillsCareer explorationConfidence buildingCommunication skillsPublic speaking
SECTION 5 Personal Development & Leadership
What motivated you to apply for the R.I.S.E Program?*
What personal goals would you like to achieve through this program?*
ConfidenceDecision makingConflict resolutionTeamworkCommunicationCommunity leadership
SECTION 6 Wellbeing Check-In
Over the past month, how have you felt?*
Very confidentSomewhat confidentNot confident
LowModerateHigh
YesSomeNot really
MentorshipMental wellbeing coachingLife skills developmentLeadership trainingCareer guidance
SECTION 7 Youth Interests & Engagement
Leadership workshopsEntrepreneurship trainingCommunity service projectsCultural learning activitiesPublic speakingSocial media campaignsYouth debates
YesMaybeNot sure yet
SECTION 8 Technology Access
YesNo
YesNo
Very comfortableSomewhat comfortableNeed help
SECTION 9 Program Commitment
The R.I.S.E Program runs in alignment with the school calendar and includes: Leadership workshops, Mentorship sessions, Youth empowerment activities, Community engagement opportunities*
Yes, This is easyNo, this is Not PossibleYes, I can try, However I have special situationNo, I would need major assistance to keep up with this
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MENTOR REGISTRATION FORM

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- Name*
  
  PrefixFirst NameLast Name
- E-mail Id*
  example@example.com
- Contact Number*
  Please enter a valid mobile no.
- Communication Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip CodeCountry
- Emergency Contact
- Name
  
  First NameLast Name
- Email
  example@example.com
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Organization*
  Current Organization
- Occupation*
- Sector*
- Profession*
- Designation*
  Current Designation
- Area of Expertise*
- Education Qualifications*
- About Me-A Short Description*
- LinkedIn*
  Please enter your LinkedIn URL
- LeadershipWomenprenuerCareer/Education GrowthCareer TransitionSocial Assistance and NavigationSelf EmpowermentElevator Pitchmental wellbeinggraduation coachinglife skills buildingHome WorkOther
- If Other, Please Specify
  Separate by comma
- No. of Hours/Month you can dedicate for this program*
  Only add numeric value
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- Should be Empty:

R.I.S.E PROGRAM

SECTION 1  Participant Information

SECTION 2  Parent / Guardian Information (If Participant Under 18)

SECTION 3  Participant Background

SECTION 4  Education & Career Interests

SECTION 5  Personal Development & Leadership

SECTION 6  Wellbeing Check-In

SECTION 7  Youth Interests & Engagement

SECTION 8  Technology Access

SECTION 9  Program Commitment

MENTOR REGISTRATION FORM

Emergency Contact

SECTION 1 Participant Information

SECTION 2 Parent / Guardian Information (If Participant Under 18)

SECTION 3 Participant Background

SECTION 4 Education & Career Interests

SECTION 5 Personal Development & Leadership

SECTION 6 Wellbeing Check-In

SECTION 7 Youth Interests & Engagement

SECTION 8 Technology Access

SECTION 9 Program Commitment