MAX Mentee Application Form (June 2018)
Thank you for your interest in MAX Mentors. Please refer to the Mentee Application Guideline prior to completing this form. Guidelines Link: https://goo.gl/5RgnbQ

Please note: submission of Resume/CV to mentors@maxgala.com is mandatory. You are welcome to attach links to websites, articles, or portfolios which further demonstrate your experience.

PART I: APPLICANT INFORMATION
First name: *
Your answer
Last name: *
Your answer
Email: *
Your answer
LinkedIn Profile Link:
Your answer
Phone number: *
Your answer
Gender *
Age: *
Your answer
Current town/city and province of residence: *
Your answer
Place of Birth: *
If "other" selected in previous question, what is your place of birth and year of arrival to Canada? *
Your answer
With which of the following racial/ethnic groups do you self-identify with the most? Check ONE only. *
What was your gross family income last year? Check ONE only *
How many people does this income support? *
Highest level of education completed: *
Your answer
If post-secondary completed, were you the first in your family to go to University/College? *
Discipline/Field *
Program: *
Your answer
Post-secondary cumulative GPA. Please provide your cGPA out of the highest GPA at your school. Example: 3.0/4.0 *
Your answer
Current occupation/job title: *
Example: "Associate for Risk Assurance Services at PwC" or "4th year Electrical Engineering Student"
Your answer
Are you and/or a member of your immediate family dependant on income benefits? (e.g. Ontario Disability Support Program (ODSP), OntarioWorks, Employment Insurance Sickness Benefits, etc.) *
Do you have any accommodation needs? *
If you answered yes to the question above, please describe your accommodation needs:
Your answer
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