Mentoring Application

* Are you applying on behalf of a youth? Yes No

* Which program(s) are you interested in? One-to-One Mentoring Quick Connect Group Mentoring Events

* First Name:

* Last Name:

* Age:

* Date of Birth:

* Street Address:

* City:

* Province:

* Postal Code:

* Phone:

Alternate Phone:

* Email:

* Preferred Mode of Contact: Email Phone Text Message

* Preferred Language: English French Other

KEYS will attempt to accommodate requests for mentorship in languages other than English whenever possible. Please be aware that we cannot guarantee to meet this request.

* Are you currently enrolled in school?: Yes No

Please tell us why you want a mentor:

Thank you for your interest in the InSight program. A KEYS team member will connect with you in the next two business days to get started.

Consent to Disclosure and Use of Personal Information

The personal information collected by KEYS is collected only for the purposes of effective delivery and evaluation of the Mentoring Partnership program and will not be shared for any other purpose. Information is collected for the purposes of: determining program eligibility; matching mentors and mentees; statistical reporting; outcomes follow up and evaluation; reporting to program funders. Information may be shared with program delivery partners, government funding partners, or corporate partners to ensure effective program delivery and program evaluation.

KEYS is committed to protecting the privacy of your personal information. All information provided will be held in confidence and will be protected in a manner that satisfies the requirements of applicable legislation. Your personal information will be retained in a secure manner and will be shared only for the purposes listed in the paragraph above.

* I Agree