Intercultural Mentorship Program: APPLICATION FORM

Welcome to the Intercultural Mentorship Program! Thank you for your interest in becoming a Mentor Partner. We hope to inspire you to look at life through someone else’s perspective, to challenge your own assumptions, to apply critical thinking and become more knowledgeable and sensitive interculturally and to enhance your overall experience at Red River College and in Winnipeg!

A good understanding of the scope and expectations of the Intercultural Mentorship Program before you apply will ensure you have a successful experience in this Program. Please continue to read.

What is Mentorship?
Mentorship is a special relationship that brings people together in an intentional, voluntary relationship. This relationship usually takes place between a person who has lived through a specific experience and a person who is new to that experience. In the Intercultural Mentorship Program, we believe that each mentor partner has lived through specific, unique experiences and we ask that you share your experience and perspective, whether Local or Global with your mentor partner. Because you may have had a different cultural experience growing up, there is much to learn from one another about how you were raised, what your life has been like, and how you view the world. Genuine interest and curiosity as well as a willingness to share are therefore essential qualities of a Mentor Partner.
In addition, good mentoring requires time and commitment and a willingness to act as a positive role model who creates a safe space where insightful conversations can be generated.

If this is you, we are looking forward to having you in the program! The commitment is 10 hours during the course of the term. Please visit www.rrc.ca/imp to learn more about the program before applying.

BASIC INFORMATION

Your RRC Student/Staff ID Number (required) (For Example: 0205048)

Your RRC Campus of Study or Work (required)

Which Type of Mentor Partner Are You?

Your Resident Status

Your Full-Time Academic Program or Staff Department (required) (For Example: Applied Accounting, Business Administration, Culinary Arts)

Your Current Semester
1st semester2nd semester3rd semester4th semesterI am Staff/FacultyOther - please fill in the blank

How Did You Hear About This Program?
Presentation by Diversity And Intercultural ServicesInstructorPATHS survey for new studentsRRC Student PortalRRC WebsiteWord of MouthPosterSA BBQRRC Staff MemberPromotional CardOther - please fill in blank

Your First Name (required)

Your Last Name (required)

Your RRC E-mail Address (required)

Your Preferred E-mail Address (required) - Do not provide a "LEARN" e-mail address

Your Home Phone Number (required) (10 Digits - For example: 204-487-7020)

Cell Phone Number (10 Digits - For example: 204-293-4958)

Your Street Address (required) (For example: Apt 204, 2005 Sherbrook Avenue)

Your City/Town (required)

What Are All Your Availabilities To Meet With a Partner? (Please check all that apply)
Off campus: weekendsOff campus: weekday eveningsOff campus: weekdays during lunch breaksOn campus: weekday eveningsOn campus: weekdays during lunch breaks

The following questions are optional but they will help us to make the best matches possible:

PROGRAM DIVERSITY

Please note that the purpose of this program is friendship and support and we do not match for dating purposes.

Your Gender Identity
FemaleTransgenderTwo-spiritGender Non-conformingMaleI prefer not disclosing my gender identityOther - please fill in the blank

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 gludusan@rrc.ca or 204-632-3847

Your Country of Origin

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

Your Year of Birth (For example: 1981)

Do You Have Children Living With You?
YesNoPrefer not to say

MATCHING AND SUPPORT

What Is Your Personal Motivation For Volunteering In This Program (if the IMP is an option for you to use towards course credit, why did you choose the Mentorship Program over other volunteer opportunities offered to you?)

What Skills/Qualities Do You Have That Would Make You A Good Mentor Partner?

Think about a person other than your parents (preferably a peer) that provided you with friendship, guidance and support. What was that person like? When you become matched, what are some of the things you might do to create that same type of friendship and support?

Tell us a little bit more about your personality and interests. Overall, what do you feel is important for us to consider in matching you? For example, any age, interests, or personality trait factors?

What expectations do you have about the relationship you may have with your mentor partner? How do you envision it to be?

Which of the following words describes yourself better?

introspectivereflectiveloudsocialoutgoingshytalkativeconscientious (plan ahead rather than being spontaneousdisciplinedadventurous

Which of the following words describes a mentor partner you see yourself most comfortable with?
introspectivereflectiveloudsocialoutgoingshytalkativeconscientious (plan ahead rather than being spontaneousdisciplinedadventurous

Can you think of any other traits or qualities about a mentor partner that would make it easier for you to interact with?

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

If You Know You Are Taking This For Course Credit, What is the Name Of Your Instructor or EP Advisor? If You Do Not Know, PLEASE SKIP THIS QUESTION

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

If For Course Credit, When Will This Course Be Finished (For Example: December 2012, April 2013?) 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 4 areas. Please read the following carefully!
YOU MUST READ AND CLICK ALL 4 BOXES BELOW IF YOU AGREE.

WHEN YOU ARE DONE, please click "Send" to submit your application.

1. 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.

SHARING INFORMATION

2. 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 e-mail 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.

SHARING MY STORY

3. 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.
YesNo

SHARING MY PHOTOS, ETC.

4. 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.
YesNo

Red River College is governed by the Freedom of Information and Protection of Privacy Act of Manitoba (FIPPA) in the collection, use, retention, safeguarding, disclosing and disposing of personal information. The personal information you provide will be used to deliver services and benefits related to the Mentorship Program. If you have any questions or concerns, contact Red River College’s Privacy Co-ordinator at Privacy@RRC.CA.

 

Red River College is governed by the Freedom of Information and Protection of Privacy Act of Manitoba (FIPPA) in the collection, use, retention, safeguarding, disclosing and disposing of personal information. The personal information you provide will be used to help us assess your request and contact you about your request. If you have any questions or concerns, contact Red River College’s Privacy Co-ordinator at privacy@rrc.ca.

We ask that you please do not reveal personal health information in the fields above.