eMentoring Application

Tell Us About Yourself!

Name*

First Last

Email*

If you are providing a school-affiliated email, please ensure you can receive messages external to your school

Age*

Grade*

School*

What province do you live in?*

If you identify as Indigenous, what is your Indigenous background? (Please leave blank if not applicable)

Tell us about you! Briefly describe some of your favourite school subjects, sports, clubs, arts, hobbies, interests, etc.*

What are your career goals? Who would you like to be? (It’s ok if you aren’t quite sure yet! Just list some career goals you have considered.)*

Below are some examples of careers in science and technology that some of our eMentors are involved in. Please indicate 2-3 that you are most interested in potentially being matched with, but remember that being assigned a mentor in any of these fields will give you the opportunity to learn more about a career that you may never have thought about.*

If other, please indicate:

Will you commit to spending 1 hour per week during the eMentoring round communicating with your eMentor via email?*

Yes
No

Your Program and Pathway

Please select the program you would like to be a part of*

We have different programs for the various communities that we serve. While the programs share the same structure, the mentors you engage with may be able to provide insights and advice more relevant and relatable to your situation, as they will have a background similar to yours

Please select the eMentoring pathway you are most interested in*

You have the option of three eMentoring pathways to pick from, based on what you would like to focus on with their mentor. You can join our program several times if you are interested in multiple pathways!

Please select the round(s) you would like to be considered for*

Our eMentoring programs have rounds in the fall and winter. We may also have summer rounds, based on demand. Please let us know which upcoming round works for you. If you do not have a preference, then please Select All.

Select All
Fall round
Spring round
Summer round

Preferred language of correspondence with your mentor*

If you do not have a preference, please Select All

Select All
English
French

Optional Video Sessions*

Mentors and mentees have the option of doing a video session in week 1 and/or week 7. Please indicate your interest in these optional video sessions

Participation and Media Release Consent

The applicant has indicated that they are interested in participating in the eMentoring Program through ms infinity. This program is part of the Society for Canadian Women in Science and Technology’s (SCWIST) Youth Engagement Initiative. Our mission is to encourage girls and young women to pursue their studies in math, science and technology and to equip them with the necessary tools they need as women in STEM fields! Please read the eMentoring Participation Guidelines to learn more about the program. Please indicate your consent to the applicant’s participation and to the use of their name or visual representations (photographs or video recordings) for SCWIST program promotion and impact reporting to our funders and official SCWIST members.

Participation Consent*

I agree to the applicant’s participation in this program

Media Release Consent: I give permission for the Society for Canadian Women in Science and Technology (SCWIST) to use the name or visual representations (photographs or video recordings) of the applicant for the following:*

Teacher/Parent/Guardian Name*

First Last

Teacher/Parent/Guardian Email*

Teacher/Parent/Guardian Phone Number*

Parent/Teacher/Guardian Signature*

Please use your mouse (if on a computer) or finger (if on a tablet) to sign in the box.

Student Signature*

Please use your mouse (if on a computer) or finger (if on a tablet) to sign in the box.

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eMentoring Application

Tell Us About Yourself!

Your Program and Pathway

Participation and Media Release Consent

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