Young Leader Intake Form Question Title * 1. What is your name? OK Question Title * 2. How would you like Canada Bridges staff to communicate with you? Email Facebook Messenger Instagram Phone call Text Other (please specify) OK Question Title * 3. Please provide contact info for whichever method you selected above. OK Question Title * 4. How old are you? OK Question Title * 5. What is your gender? Male Female Prefer not to say Other (please specify) OK Question Title * 6. What is your home community, reserve, or settlement? OK Question Title * 7. What are your goals for moving to Calgary? Education Employment Other (please specify) OK Question Title * 8. If you are registered to attend school, please indicate which school you are attending. Mount Royal University (MRU) Southern Alberta Institute of Technology (SAIT) University of Calgary (UCalgary) St. Mary's University Bow Valley College Alberta College of Art and Design (ACAD) Other (please specify) OK Question Title * 9. Are you interested in being matched one to one with a mentor? Yes No OK Question Title * 10. If you answered yes to the question above, what kind of support do you want from a mentor? OK Question Title * 11. If you want to be matched one to one with a mentor, would you want a mentor to help with any of the following? You can select as many answers as you want. Job search/employment Getting into school Doing well in school Navigating the city (example: learning how the bus or CTrain system works) Find cool and fun places to check out in the city Cultural support Accomplishing goals (maybe through helping set goals, following through, checking in) Building confidence Developing life-skills (examples, cooking, banking, budgeting, etc.) Emotional support Adjusting to city life OK Question Title * 12. Do you want your mentor to have the same gender as you? Yes No Doesn't matter I don't want to be matched one to one with a mentor OK Question Title * 13. What else should we know about you? (You might want to tell us more about your goals, what you're looking for support with, ideas you have for hangouts, or what's important to you - anything you feel would help us make the mentorship program better for you!) OK Question Title * 14. Please let us know if you have any allergies or medical concerns we should be aware of. OK Question Title * 15. Please provide the name and number of someone who can be your emergency contact. Your emergency contact is who we would call if something were to happen at one of our events. Name Number OK DONE