Influence Mentoring
Proof of Student Enrollment Requirement

In order to be eligible, all Protege applicants must provide a current Proof of Enrollment (dated applicable to current semester) to the Executive Director of Influence Mentoring at executivedirector@influencementoring.com. Proof of enrollment forms are available by request from the Office of the Registrar of your institution.

By completing this registration you hereby provide your express consent to Influence Mentoring Society to share your personal information with your post-secondary institution or school for the sole purpose of administering the mentorship experience, including but not limited to, the following circumstances providing contact information, matching, follow up, feedback, and check ins.

iProtégé Information
* First Name
Middle Names (If any)
* Last Name
Traditional Name(s) or Preferred Name(s)
* Indigenous Heritage
First Nations
Inuit
Métis
Non-Status
* Email
* Password
* Confirm Password
Unit/Apartment #
* Street Address
* City
* Province/Territories
-- Select --
* Postal Code
* Country
-- Select --
Other

Search:
* Daytime Telephone #
Mobile Phone
* Date of Birth
* To which gender do you most identify?
Female
Male
Two--Spirit
Transgender
Non-binary/gender non-conforming
Questioning/Unsure
Additional Identity Not Listed _______
I prefer not to answer
I identify as:
Family Origin (Nation, Band, Settlement, etc.)
iProtégé Secondary Questions
Please upload a copy of your resume.
(PDF, DOC, JPG, TXT)
No file is currently uploaded.
Upload File

Click the "Upload File" button above or drag and drop a file over the "Upload File" button to upload.
 
LinkedIn Profile
Do you have a website?
Yes
No
Website
Career Goals
Educational Goals
iProtégé Language Information
* First Language
English
Spanish
German
French
Russian
Other
Other Languages
English
Spanish
German
French
Russian
Other
Other
iProtégé Personal Interests
What personal interests do you have?
Do you have any hobbies?
Do you live an Indigenous traditional and/or religious life?
Yes
No
Explain
Do you have anything you would like to share that makes you uncomfortable in conversation or any other form of interaction with other people?
Anything else you would like to share that may help with the iMentor matching process?
iProtégé Profile & Future Goals
iProtégé Education
* Influence Mentoring Stream
-- Select --
* Explain
* Highest Level of Education?
Less than High School
High School
High School Plus
Some College
Associates Degree
Bachelors Degree
Masters Degree
Professional Degree
Pre School Plus
Doctoral Degree

iProtégé Employment
* Please select the closest match to your current profession.
Accounting
Administration
Agriculture
Architect
Banking
Construction
Consulting
Culture/Recreation
Education
Engineering
Finance
Government and Public Service
Health Services
Hospitality and Tourism
Human Resources
Information Technology
Lawyer
Management
Management and/or Administration
Manufacturing
Non profit
Oil and Gas
Project Management
Publicity and Marketing
Sales
Science and Technical Services
None
Telecommunications
Transportation
Other
Other
* Please select the profession(s) that most closely match your career goals?
Accounting
Administration
Agriculture
Architect
Banking
Construction
Consulting
Culture/Recreation
Education
Engineering
Finance
Government and Public Service
Health Services
Hospitality and Tourism
Human Resources
Information Technology
Lawyer
Management
Management and/or Administration
Manufacturing
Non profit
Oil and Gas
Project Management
Publicity and Marketing
Sales
Science and Technical Services
None
Telecommunications
Transportation
Other
Other
* What is the primary industry you have worked in?
Accommodation and Food Services Administration
Agriculture
Entertainment and Recreation
Educational Services
Finance and Insurance
Healthcare and Social Assistance Information
Manufacturing
Professional, Scientific and Technical Services
Real Estate and Rental and Leasing
Retail Trade
Transportation and Warehousing
Wholesale Trade
Other
None
* What is the secondary industry you have worked in?
Accommodation and Food Services Administration
Agriculture
Entertainment and Recreation
Educational Services
Finance and Insurance
Healthcare and Social Assistance Information
Manufacturing
Professional, Scientific and Technical Services
Real Estate and Rental and Leasing
Retail Trade
Transportation and Warehousing
Wholesale Trade
Other
None
Other
Other

Mentorship Questions
* We are interested in how you heard of (found?) us! Please let us know
-- Select --
Other
* Best time to reach you by the program manager?
Morning
Afternoon
Anytime
* How would you prefer to be contacted?
Daytime phone
Mobile
Email
Mail
* Are you open to being matched with an iMentor outside of your field of study?
Yes
No
* Preferred Communication Methods
Zoom
Teams
Webex
Phone
Email
In-person coffee
Other
Other
* Preferred iMentor Gender
Female
Male
Two--Spirit
Transgender
Non-binary/gender non-conforming
Questioning/Unsure
No Preference
Other
* Preferred iMentor Indigenous Status
Indigenous Person
Non-Indigenous Person
No Preference
* Preferred Meeting Times
Week day morning
Week day afternoon
Week day evening
Weekend morning
Weekend afternoon
Weekend evening
Other
Other
Consents
Consent to Collect, Store and Share Information
I hereby provide my express consent to Influence Mentoring Society to collect, store, and where relevant and applicable to the operation of the Influence Mentoring Program, share with third party providers directly related to the operation of the Influence Mentoring Program, the personal information provided herein, and as may be further provided by me as part of the Influence Mentoring Program. I understand the said information will be collected, stored and shared (as aforementioned) only for the purposes of carrying out all operations and activities related to the Influence Mentoring Program. Further, said information will be dealt with in accordance with the terms and provisions of the Influence Mentoring Society Privacy Policy, a copy of which may be obtained and/read at https://www.influencementoring.com/influence-privacy-statement.

* Consent to Collect, Store and Share Information
Consent to Share Information with Your School
I understand that my post-secondary institution may be directly related to the Influence Mentoring Program. Where that is the case, I hereby provide my express consent to Influence Mentoring Society to share my personal information with my post-secondary institution for the sole purpose of administering the Influence Mentoring Program including but not limited to, the following circumstances providing contact information, matching, follow up, feedback, and check ins.

Consent to Share Information with Your School
Code of Conduct
Please review the Influence Mentoring Program Code of Conduct here.
I hereby confirm that I have read, I acknowledge, and I agree to abide by the terms and conditions of the Influence Mentoring Program Code of Conduct.

* Code of Conduct
Media Consent
I hereby provide my express consent to Influence Mentoring Society to share my image (videos and photos), comments and personal story on Influence Mentoring’s website, social media platforms, and in reports to funders. I consent to the collection, storage and use of said personal information for the purposes aforementioned.

* Media Consent
Yes
No
Consent for Contact Post-Mentoring
I hereby consent to Influence Mentoring to contact me for post-mentoring surveys, interviews and comments regarding my participation in the Influence Mentoring Program.

* Consent for Contact Post-Mentoring

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