If you are interested in having a mentor or you are interested in your child having a mentor, please fill out the following form.
Youth's First Name
Youth's Last Name
Name of School
Primary Residence Address
Parent / Guardian 1 Name
Relationship to Youth (Mother, Father, Other: Please Specify)
Parent / Guardian 2 Name
Emergency Contact Name
Emergency Contact Phone Number
Saskatchewan Health Card Number
Please answer all of the following questions as completely as possible. These answers will assist in the matching process.
Why do you/your child want a mentor?
What type of person would you like to be matched with?
Briefly describe your expectations of the mentoring program:
One of the program requirements is to communicate with the Program Administrator or Executive Director about your relationships with you and your mentor. Are you okay doing that?
Are you/your child able to meet with a mentor a minimum of 2 hours per week? Please explain any scheduling issues you may have.
What types of activities would you like to do with a mentor?
What are your interests or hobbies?
Please describe your/your child’s friendships:
Are you/your child currently having problems either at home or at school? If yes, please explain.
Have you/your child experienced any traumatic events (ex: death in family, abuse, divorce)? If yes, please explain.
Can you provide any additional background information that may be helpful in matching you/your son/daughter with an appropriate mentor? (Anything that we should be aware that could be a trigger for you or your child)
Do you have any religious preferences you would like for us to take into consideration?
Is there anyone your child should not have contact with?
Is there anything else the SCCYI should be aware of before we move forward with matching you/your child with a mentor?
Please read carefully before submitting:
Thank you for your interest in having a mentor. All information provided in this application is confidential and will only be used as a means to provide a successful mentoring match.
By continuing, I agree that all of the above information is true and agree to have my child participate in the SCCYI Mentoring Program.