Mentee Application Form

Before you fill out the mentee application form, please make sure you qualify by answering 'yes' to the following questions: -Are you a youth between the ages of 10-16? (Once you are on the waitlist or matched, you can remain in the program until you are 18, but we generally accept applications until youth is 16. Exceptions may be made outside of this age range, just know your chances of being matched are lessened) -Do your guardians approve and support you being in The Center mentoring program? -Are you willing to meet with your mentor 2 hours a week for one year? -Do you understand that wait times vary before a match with a mentor may be found? -Are you ready to build a relationship with a mentor and be open to new experiences? -Do you understand that the program will be conducted in a safe, structured environment and you will communicate any concerns or issues that arise to your mentor or Program Administrator?

Youth Section This section must be completed by the youth applicant. If you need help, a parent or guardian can assist you, but it is important that the responses are your own. This is your opportunity to tell us more about yourself and what you're looking for in a mentor!

Youth's First Name Youth's Last Name Birth Date Age Gender Name of School Grade Why do you want a mentor? What type of person would you like to be matched with? What are your hobbies or interests? What are some of your strengths or things you're good at? What would you like to do with a mentor? Are you having problems at home or school? (ex. friend drama, parents separating, peer pressure, mental health, etc.) And if you are, please explain. Are you willing to open up to a mentor about these challenges?

Do you have close friends? Yes, LOTS!One or twoNoIn the past but not now

Do you have any religious preferences? Do you have any past traumatic events or triggers we should be aware of? Is there anything else that might be helpful for us to know?

Parent/Guardian Section This section must be completed by the youth's parent or guardian. Please provide us with important information about your child, including any support needs or concerns, that will help us match your child with the best mentor. Your input and support is vital to ensuring a safe and successful mentoring experience.

Parent / Guardian 1 Name Relationship to Youth (Mother, Father, Other: Please Specify) Parent/Guardian Email Work Phone Cell Phone Street Address City Province Postal Code Parent / Guardian 2 Name (if applicable) Relationship to Youth (Mother, Father, Other: Please Specify) Parent/Guardian Email Work Phone Cell Phone Street Address City Province Postal Code Emergency Contact Name (only fill out if you do not have a second parent/guardian) Emergency Contact Phone Number Does Mentee primarily reside with Guardian 1, 2, both or neither? Allergies/Medications Has your child had a mentor in the past? If yes, please provide details If you live outside of Swift Current, are you willing to share the transportation responsibility with the mentor? Does your child have any specific goals or things they would like to achieve through mentoring? Are there any cultural or family values that should be considered when pairing your child with a mentor? Is your child open/able to receive feedback and guidance from a mentor? This gives insight into how the youth may respond to the mentoring process. What type of mentor do you think would be a good match for your child? Are you willing to arrange a 2 hour/week meeting with your child and their mentor? Is there anyone they should not have contact with? Is there any additional background information that might be helpful for us to know? Do you have any additional questions for us?

Thank you for your interest in having a mentor. You will hear back from the Program Administrator shortly to schedule your initial interview. This quick meeting is for us to get to know you and your parent/guardian better. After the meeting, you will be placed on our waitlist while we work to find a suitable mentor for you. Please be aware that it may take some time to find the best match, but we are always available for questions and support through this process. All information provided in this application is confidential and will only be used as a means to provide a successful mentoring match.

For Parent/Guardian to sign:

I acknowledge that this consent form will be filed at the SCCYI: The Center.
I understand that my child will be contacted by the Program Administrator to supervise and monitor the relationship with their mentor.
I understand that my child should not have contact with their mentor outside of the scheduled sessions and planning of sessions.
I agree to inform the Program Administrator if I choose to withdraw my child from the program.
I release the Swift Current Community Youth Initiative: The Center (including all partners) and their employees, directors, and volunteers from any cause or action or claim for damages arising form my child’s association with the Mentoring Program, or with the Swift Current Community Youth Initiative in its entirety.
I consent to my child being transported to and from activities and sessions by the mentor.

By continuing, I agree that all of the above information is true and agree to have my child participate in the SCCYI Mentoring Program.

For Mentee to sign:

I understand that it may take awhile before a suitable mentor is found for me and it is not guaranteed that an appropriate mentor will be found before I phase out of the program.

By continuing, I agree that all of the above information is true and agree to participate in the SCCYI Mentoring Program.

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