BIPOC MEP Student Mentee Application Form
Welcome and congratulations for taking this first step. The BIPOC Mentorship Program is a formal, evidence-based program that supports respectful and individualized mentorship to:
1. Help increase the graduation rate of competent midwives
2. Mitigate against the trauma experienced by so many BIPOC midwifery students
3. Promote resiliency and professional skills that will prepare BIPOC midwifery students for a long career in a stressful but valued profession.

Privacy statement:
The information that is provided in the mentor and mentee applications remains completely confidential and is stored on Ryerson’s Google drive in a password protected, encrypted folder. Only the Mentorship team has access and uses this information at your request for pairing based upon the most characteristic you choose. The mentorship team currently is composed of Karline Wilson-Mitchell, Bahja Ali (RU student RA), and Tumaini Lyaruu (RU student RA). We don’t share all of your demographics with the midwife or student pairs, we only share the ones that are high priority that you request we share.  Instead, we would hope that the mentorship pair will share all of these details with each other as they get to know each other.

Please complete this form and reply to We will try to pair you with a mentor asap.

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Email *
Let's get to know you better.  
Name: *
Phone number: *
Please select your preferred method(s) of communication. Please note that in-person and video conferencing are strongly recommended as these methods significantly enhance the mentoring experience and relationship. *
Which MEP or University do you attend? *
If you are studying somewhere else in Canada or out of country please explain.
Clinical placement location (if applicable)
Which year are you in? *
What practice setting would you most like to work upon graduation?  (Please check whichever are applicable) *
If you are on medical or maternity leave please explain. This will not prevent you from receiving a mentor.
Do you have local support? *
If yes, what type of support do you currently have? This will not prevent you from receiving a mentor.
Type of support you are hoping to receive: *
Please list your self-identified cultural and/or ethnoracial group membership (e.g. Ethnoracial heritage, nationality, culture, place of birth etc.). This is used for matching purposes. *
Is there anything special that you would like us or your mentor to know about you? (Some mentees may be interested in matching based upon: geographically in the same region of their placement or your residence, race, culture, place of birth, gender, sexual orientation, ability, parenting status, over 40 years of age, language etc.) You may name as much or as little as you'd like. This information remains private and confidential in an encrypted, password protected Ryerson Google Drive and the BIPOC Mentorship Program Team abides by Canadian privacy laws: *
Are there any additional supports would would need from us? (e.g. accessibility, information etc.):
Do you have any comments or suggestions for the mentoring program?
Would you like to help to improve and grow the mentoring program? *
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