Mentor Registration Form

As a part of the Region of Waterloo Upstream initiative, the CCAWR will be launching a mentorship program in 2023. Our mission is to connect people in the African, Caribbean, and Black (ACB) communities in Waterloo Region. This initiative will focus on creating a safe environment where mentees and mentors can learn, connect, and grow. By completing this survey, we will gather information that will inform us on how to match mentors/mentees effectively as we strive to meet our goals of promoting Equity, Diversity and Inclusion (EDI) for all racialized groups. Through this initiative, we hope to creating a cohesive and resilient community that models representation, equity and diversity and moves individuals closer to their stated goals.

Become a Mentor and Make an Impact!

Join our Region of Waterloo Upstream Mentorship Program,

Oct 16 – Nov 24, 2023

Be a mentor and help connect and uplift the African, Caribbean, and Black (ACB) communities in Waterloo Region. Shape effective matches, promote Equity, Diversity, and Inclusion (EDI), and build a united, diverse community. Make an impact – sign up as a mentor now by completing the form below! (Note: Registration does not guarantee your selection as a mentor.)

CCAWR Mentor Survey

CCAWR Mentor Survey

5. City/Township
7. Preferred method of contact (NOTE: Please ensure you provide the information for the preferred method.) *
10. Ethnicity/Cultural Identity (OPTIONAL: The answer from this question will be used to match you with a mentee that you will be comfortable with and is best suited to your goals, as outlined in question 19 below)
11. Do you have a current Vulnerability Sector Check (i.e. Police Check)? *
12. Have you had training and/or education related to conflict resolution, anti-racism, anti-oppression or similar topics? *
15. Would you be willing to do a seminar on a topic that your are knowledgeable about? *
16. If you said YES to question 15, please select which of the options below you would be willing to present on.
19. Would you like to be matched with a mentee that shares similar interests and characteristics?
20. Please select the options for which you would be available to meet with your mentee? *
21. How many hours a week would you be able to mentor? (This would be in addition to the 1 hr. weekly workshop or seminar)
22. How many mentees would you be comfortable mentoring in this program? *
23. Are you willing to attend a training and orientation session on October 1st prior to being selected as a mentor? *