Intent to apply as a MENTOR (Community Agency Lead mentor or Academic mentor)

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* 1. Your name (the person who intends to be the mentor)

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* 2. Mentor's preferred pronouns

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* 3. What type of mentor do you intend to apply to the Triadic Mentorship Program as?

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* 4. Please tell us about yourself.

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* 5. How did you hear about the AVA Triadic Mentorship program? (please write yes beside your selection unless asked to specify)

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* 6. Do you have a scholar (i.e.graduate student or post-doctoral fellow) whom you would like to mentor in this program?

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* 7. Do you have a mentor in mind with whom you would like to partner with to mentor a scholar? For example, if you are advising us of your intent to apply as an academic mentor, do you know of a community partner agency that would mentor a scholar in partnership with you (or the other way around)?

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* 8. If you are a community partner agency staff, have you or do you plan to apply for the AVA community parter agency funding to participate in the Triadic Mentorship Program?

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

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* 10. Please tell us what skills or expertise (e.g. community-based research, grant writing, early childhood adversity, etc) you will contribute to a Triadic Mentorship relationship.

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* 11. Do you have experience as a mentor?

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* 12. Are able to commit to monthly meetings (at the very least) with the scholar you are mentoring? (Please check all that apply)

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* 13. 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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* 14. Are you able to commit to completing core courses (i.e. AVA Basics), which is part of the AVA Online program, and becoming familiar with the additional optional courses so you may be able to recommend courses that align with your scholars’s learning plan and research career goals?

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* 15. Are you able to commit to attending 2 virtual ‘check-in’ sessions per term with your triad and 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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* 16. Please tell us how you/your organization and your current work is in alignment with the above AVA objectives. (Max 100 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 the 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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* 17. What is your gender identity?

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* 18. What city and province are you in?

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* 19. What languages are you fluent in?

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

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

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* 22. 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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* 23. Is there anything else you would like us to consider regarding your interest in participating in the AVA Triadic Mentorship program as a mentor?

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

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