Breadcrumb Home Student Supports Indigenous Initiatives Indigenous Mentorship: Mentees Indigenous Mentorship Registration Form For Mentors Indigenous Mentorship Registration Form for Mentors The mentor’s role is to welcome you into the OII and University setting and help to create a sense of belonging for the mentee. Registration Information First Name Last Name Preferred Name Program of Study - Select -Ancient StudiesAnthropologyBiologyBusiness AdministrationChild and Family StudiesCommerceComputer ScienceCriminal JusticeData ScienceEconomicsEducation (Consecutive)English StudiesEnvironment and Physical GeographyEnvironmental Biology and TechnologyEnvironmental GeographyEnvironmental ScienceFine ArtsGender Equality and Social JusticeGeographyHistoryIndigenous StudiesLiberal ArtsLiberal ScienceMathematicsNursingPhilosophyPhysical and Health EducationPolitical SciencePsychologyReligions and CulturesSocial Welfare and Social DevelopmentSocial WorkSociologyMaster of Arts in HistoryMaster of Arts in Sociology - Applied Social ResearchMaster of EducationMasters of Environmental Science/StudiesMaster of Science in KinesiologyMaster of Science in MathematicsPhD in Education (Educational Sustainability)Undeclared / UndecidedOther Year of Study - Select -1st2nd3rd4th Student Number Nipissing University Email Address Address (Line 1) Address (Line 2) City Province - Select -AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code Home Phone Number Cell Phone Number Work Phone Number Please list any allergies/food sensitivities/dietary restrictions, etc. EpiPen Yes No Language(s) Spoken Cree Ojibway English French Other… Enter other… Emergency Contact Information First Name Last Name Phone Number I give permission to Nipissing University to include my photos taken by staff, and/or occasional videotapes taken by local media. I understand these photos may be used for promotional purposes (e.g. slide show, website photo gallery, brochures, displays, advertisements, etc.), but no names will be used. I hereby release Nipissing University, its agents, employees and volunteers from all liabilities, claims, demands, actions and causes of action of any nature arising from or related to any injury, including death, suffered by the student, including any damage, loss, theft or destruction of property, injury or death resulting from the negligence of the Faculty, Nipissing University, its agents, employees or volunteers, while attending, participating in or travelling to or from any of the activities completed in the Peer to Peer Program. If you have any questions, please contact the Indigenous Mentorship Coordinator at indigenousmentorship@nipissingu.ca. Protection of Privacy The information on this form is collected under the authority of the Nipissing University Act, 1992. It is related directly to and needed by the University to support your request for Wiidooktaadwin Indigenous Mentorship activities with a community partner organization. Employees of the Wiidooktaadwin Indigenous Mentorship Department, Enji giigdoyang, Office of Indigenous Initiatives and the secondary school that you will be partnered with will use the information. If you have any questions about the collection, use, and disclosure of this information, please contact: Wiidooktaadwin Indigenous Mentorship Initiatives, Nipissing University, 100 College Drive, North Bay, ON, P1B 8L7
