Application for Membership Step 1 of 5 - Organization Information 0% Thank you for your interest in becoming a partner with the Ontario Mentoring Coalition (OMC). Please review and complete the below Partnership Application and submit it to OMC. Please note that this partnership application may take up to 30 minutes to complete. Allow yourself the time to complete the entire application, as you won’t be able to save your entry mid-way. If you would like to review the information being asked in the application prior to completing it, please email us at email@example.com. Tools, guides, and sample documents are available on the following websites to support you in building a quality mentoring program: www.ontariomentoringcoalition.ca www.albertamentors.ca www.mentoring.org Should you have questions or require further support to fulfill the criteria, please contact OMC. We are happy to support the great work you are doing in the mentoring field. Name*Please enter the name of the individual filling out this application. First Last Email Organization InformationLegal name of organization or agency* Office Phone*Office E-Mail*Note: This e-mail will be used as your contact e-mail on your partner profile page. FaxWebsite Mailing address*City*Province*AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukonPostal Code* Organization ContactPosition*The position of your organization contact.Select OneExecutive DirectorGeneralCommunity ProgramsFund DevelopmentMarketing/CommunicationsCommunity InvestmentSchool PrincipalOtherPosition Other*If you answered other to your position. Please type in your position title.Name*Please enter the first and last names of the main contact for your organizationTitleSalutationMr.Mrs.Ms.MissDr.Rev.Hon.Phone*Please enter the main phone number for your organizations main contact.FaxCellEmail* Preferred method of contactEmailPhone Location of Organization*Select OneRuralUrbanOrganization Inception*When was your organization founded? (year)Ontario Mentoring Please check if you are an Ontario Mentoring Coalition Partner. Do you collaborate with any other agencies or not-for-profit organizations to deliver your programs?*YesNoIf yes, which ones?Which other agencies or not-for-profit organizations do you collaborate with?Number of Ontario employees*Select One< 1011-2526-5051-7576-100101-250251-500501-1000> 1000Organization Description*Provide a brief description of your organization and the region(s) you serve for your online OMC profile.Programs & Services Offered*Provide a brief description of the programs you deliver to children and youth, as well as any other relevant information, for your online OMC profile.Area of core focus*Identify the models your organization uses to deliver mentoring programs (check all that apply) Peer mentoring One-to-One Mentoring Group Mentoring Cross-age Mentoring (eg. high school student with elementary student; senior with teenager) E-mentoring In School Mentoring Informal Formal Other Other Areas of Core Focus:*You selected "Other" as an area of core focus. Please insert any other areas of core focus here.Please identify the children and youth your organization serves:Ages*Check all that apply 0-4 5-10 11-15 16-18 18-24 Please identify any specific populations your organization servesCheck all that apply Children/Youth in Care Indigenous Children/Youth Children/Youth with a Disability LGBTQ Children/Youth Girls/Women Boys/Men Other Which 'Other' populations does your organization serve?* How did you hear about the Ontario Mentoring Coalition?*What are you hoping to gain and offer as a member of the Ontario Mentoring Coalition?*How can the Ontario Mentoring Coalition best support your organization and mentoring initiatives?* By submitting this application, I verify that*You need to agree to all of the following options for the form submit button to appear. The information communicated in this application is true, accurate and current. My organization has authorized and approved the submission of this document. My organization will do everything in its power to fulfill the requirements as stated in the Ontario Mentorship Coalition Criteria. My organization understands that they can request to be removed as an OMC Partner at any time by notifying firstname.lastname@example.org My organization agrees to support evaluation activities to contribute to OMC’s sustainability, including the provision of data related to how OMC resources and supports have contributed to program development, when requested. OMC would like to list your organization as a new member on the website. Do you consent to having OMC share your organization name and profile on the website?*YesNoSubmitted by*Please type your name.Submission date*Please choose todays date. Date Format: MM slash DD slash YYYY Once received, the Alberta Mentoring Partnership will review your application and notify you of acceptance. Note: The Submit button will not appear until you have selected and agreed to each of the "By submitting this application, I verify that" checkboxes above.EmailThis field is for validation purposes and should be left unchanged.