Intent to apply as a SCHOLAR 

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* 1. What is the name of the person who intends to apply as a scholar? (First, Last)

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* 2. What are the preferred pronouns of the person who intends to apply as a scholar?

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* 3. What type of scholar are you?

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* 4. Please tell us about yourself.

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* 5. Do you have all or part of a triad established? (i.e. academic mentor and/or community agency mentor). Check all that apply.

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* 6. I have read and understood the full Triadic Mentorship Guidelines and Appendices.

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* 7. Please tell us about your qualifications and any applicable excellence (e.g. grades, awards, community volunteerism)

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* 8. Please tell us what knowledge or experience you hope to gain from the Triadic Mentorship relationship (max 100 words).

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* 9. Are able to commit to monthly meetings (at the very least) with your mentors?

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* 10. Are you able to commit to participating in AVA’s Strategy Development, Management and Evaluation Training (i.e. Strategic Planning), and Implementation Science Training Programs (if you have not already been doing so)?

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* 11. Are you able to commit to completing core courses (i.e. AVA Basics) and courses at the intermediate and advanced levels, which are part of the AVA Online program.

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* 12. Are you able to commit to attending 2 virtual ‘check-in’ sessions per term with your triad and the other AVA triads in your cohort?

AVA’s Objectives
· Strengthen and build capacity to transform population (community) health and social services to promote the health and wellness of girls, women, and gender-diverse people, at risk/affected by violence and adversity over the lifecycle;

· Use a collaborative, innovative, cross-sectoral/disciplinary/jurisdictional training platform to train hundreds of Canadian service providers and academics in the social services/community health field working with this population; and

· Make intergenerational and population impacts, and promote a positive lifespan for girls, women, and gender-diverse people.

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* 13. Please tell us how your research and/or career goals/interests align with the above AVA objectives. (Max 200 words).

The following questions will help us ensure that we are honouring the AVA Equity, Diversity, Inclusion and Accessibility (EDIA) guiding principles. As it pertains to recruitment, the AVA's EDIA Guiding Principles are:

1)    Priority will be applied to Indigenous, Black and Other racialized people, as well as disabled, gender-diverse and other identities.
2)    We will seek equity by removing systemic barriers and biases in recruitment, application and participation processes.
3)    We will ensure diverse perspectives and lived experiences (e.g. races, places of origin, religions, immigrants and newcomers, etc.) are represented amongst the AVA team.
4)    We will focus on inclusion by valuing and respecting all contributions, particularly eliminating hierarchies, by treating team members equally.
5)    Seeking to address the 2 key objectives of te Government of Canada’s EDI Tri-Agency Action Plan for 2018-2025 by ensuring fair access to Tri-Council resources and ensuring equitable participation in recruitment of trainees (i.e. Triadic Mentorship Program).

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* 14. What is your gender identity?

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* 15. What city and province are you in?

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* 16. What languages are you fluent in?

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* 17. If you identify as a racialized person, please tell us how you identify.

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* 18. Do you have a (dis)ability?

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* 19. If you have any other diverse perspective(s) or lived experience(s) we should take into consideration, please use the field below to tell us about it (e.g. newcomer, immigrant, multiple intersecting identities, etc.).

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* 20. Is there anything else you would like us to consider regarding your interest in participating in the AVA Triadic Mentorship program?

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* 21. Please tell us if you have any feedback on the Triadic Mentorship process.

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