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National Mentorship Program Registration

The purpose of this registration is to assist in the process of pairing Mentors and Mentees within the UBC National Mentorship Program.

Before starting this survey, please ensure that you have completed the Mentor or Mentor Pathway Training courses through the UBC Membership portal and attended a one-day in-person session. Once these requirements are fulfilled, you may proceed with the registration.

If you're solely interested in taking mentorship training and do not wish to be paired with a Mentor or Mentee, please do NOT complete this form.

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* 1. What is your legal name?

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* 2. What is your preferred name? (If applicable)

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* 3. UBC Number:

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* 4. Please fill in your full mailing address and contact info:

Address

City/Town

Province

Postal Code

Email Address

Phone Number

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* 5. What local are you a member of?

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* 6. I would like to become:

Mentor

Mentee