Intercultural Mentorship Program : Red River College: Diversity on Campus

Basic Information

First Name *

Last Name *

RRC Email *

(For example: jsmith@academic.rrc.ca)

Home Email *

Home Phone *

(10 Digits - For example: 204-487-7020)

Mobile Phone *

(10 Digits - For example: 204-487-7020)

Address *

Address

City

State/Province

Zip/Postal

Student/Staff Number *

(For Example: 0205048)

Your Academic Program or Department *

Your campus *

Notre Dame Campus

Exchange District Campus

Stevenson Campus

OtherOther

Which Type of Mentor Partner Are You? *

Global Mentor - I am an INTERNATIONAL student or IMMIGRANT student. I would like to be paired up with a Canadian-raised student or staff person for cultural exchange, a chance to learn about Canadian culture, language practice and friendship

Local Mentor - I am a CANADIAN-RAISED student or staff. I would like to be paired up with an international student or immigrant student for cultural exchange, friendship and a chance to develop myself personally and professionally

Country of Origin *

If Country of Origin is Outside Canada, Your Year of Arrival in Canada (For example: 2011)

Resident Status *

Canadian Citizen

Permanent Resident

International Student

Refugee Claimant

Program Diversity

The following questions are optional but they will help us to make the best matches possible. Please note that the purpose of this program is friendship and support and we do not match for dating purposes.

You may be matched with someone who is very different than you – this is part of what makes the program so valuable, and it is how we learn about others! As a result, you may be matched with someone who is a different:

- Culture than you
- Religion than you
- Gender identity than you
- Age than you
- Marital status than you
- Sexual orientation than you
- Physical or mental ability than you

If you have concerns about being paired up with someone who is part of one of the groups listed above, please contact the Mentorship Program Coordinator at imp@rrc.ca or 204-632-3847.

Year of Birth

Do you have children living with you?

Yes

No

Prefer not to say

Matching and Support

Why are you interested in becoming part of the mentorship program?

What skills/qualities do you have that would make you a good mentor partner?

Describe your personality.

Please list your hobbies, interests, and extracurricular activities. The more detailed information you provide, the easier it will be to make a potentially good match.

Can you think of any other traits, qualities or interests about a mentor partner that would make it easier for you to interact with? For example, any age, interests, or personality trait factors.

Course Credit

The Intercultural Mentorship Program has partnered with various academic programs so that you can transfer your learning from the Intercultural Mentorship Experience towards course credit.

Are You Planning to Transfer Your Learning From The IMP Towards Course Credit?

Yes - my instructor has already told me this can count for course credit

No - this is just for voluntary reasons

I am not sure - I need to find out from my instructor if this is allowed for course credit

If For Course Credit, What is the Name Of Your Course? If You Do Not Know, PLEASE SKIP THIS QUESTION

Other

In the space below, please provide any other details about yourself (personal interests, personality, type of mentor partner you think might be best suitable for you, what you're looking for in this mentorship experience etc). This will help us in the matching process.

Permissions

This final section requests your agreement and permission in 5 areas. Please read the following carefully! YOU MUST READ AND CLICK ALL 5 BOXES BELOW IF YOU AGREE.

I agree, that if there are any reasons that I cannot continue in this program, I will notify my Mentor and the Mentorship Program Coordinator. *

I agree

I agree that while acting within the scope of the Intercultural Mentorship Program, I will conduct myself appropriately and in accordance with College policies. Without limitation, I shall at all times engage in lawful activities and conduct myself in a safe and respectful manner towards others. I agree that typical activities between mentor partners shall take place in a safe, public and visible environment. *

I agree

I give Red River College permission to use the information above for matching and eligibility purposes in the Intercultural Mentorship Program. I also give Red River College permission to share my name, my stated gender identity, my email address, my phone number(s), and my program and campus of study with the mentor partner that is selected as my match for the purposes of contacting one another. *

I agree

I give Red River College permission to use the feedback I provide about my program experience for the purposes of sharing testimonials with the College in support of the program. *

Yes

No

By checking the box below, you are stating: I hereby consent to each and every use by the Board of Governors of Red River College (the “College”), and all of its officers, employees, agents, and partners, of each photograph and any other likeness of me. Such uses may include, but are not limited to: Every use in a program, catalogue, schedule, newspaper, brochure, advertisement, or other publication or recording that describes, portrays, publicizes, or advertises the College or any College operation, and every reproduction, republication, and other re-use of the same. I also hereby waive any right to compensation for such uses, and any right to inspect or approve the uses beforehand. I hereby release the College, its legal representatives, and all persons acting under its permission or authority, from any liability by virtue of any blurring, distortion, alteration, optical illusion, or use in composition form, whether intentional or otherwise, that may occur or be produced in taking of said picture or in any subsequent processing thereof, as well as any publication or other uses thereof. I understand that these photographs or other likeness may be used only for educational or College promotional purposes or for the dissemination of information relating to the College in general. I declare that I am of legal age and have every right to contract in my own name in the above regard. *

Yes

No

Diversity on Campus

Intercultural Mentorship Program

About the Program

Apply Today

Basic Information

Program Diversity

Matching and Support

Course Credit

Other

Permissions

Service Learning Approved

Term Schedules

Hear from Mentors

Privacy