Elevate & B-You Intake Form

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The following application will allow our leadership team to cater the program to your needs, please complete it fully and honestly. All information provided on this form is only to be used by the Executive Team at Elevate and B-You and will be kept confidential.

We require your address so that we can send your honorarium to you at the end of the program.

Email *

Name *

Gender *

Female

Male

Transgender

Non-Binary

Two-spirited

Gender Queer

Prefer not to say

Other:

Do you identify as someone who is a part of the LGBTQ2S community? *

Yes

Do not wish to disclose

Email *

Social Media Handle

Phone Number *

Mailing Address *

Birthday *

YYYY

Which Race/Ethnicity do you most identify with? (Select all the apply) *

Black/African

Black/Caribbean

Indigenous (First Nations, Metis, Inuit)

White/Caucasian

South Asian (Afghan, East Indian, Pakistani, Sri Lankan)

Southeast Asian (Filipino)

East Asian (Korean, Vietnamese, Chinese, Japanese, Cambodian)

Middle Eastern (Iranian, Syrian, Iraqi, Lebanese)

Latin American

Prefer not to disclose

Other:

Required

How were you referred to our program? *

For Youth Initiative

Weston Frontlines

Elevate

School

Other:

What is the level of education you are currently pursuing? *

Grade 9

Grade 10

Grade 11

Grade 12

Undergraduate Degree

Not in school

Other:

Name of School

How much work experience do you have? *

None - ' I have never held a co-op, volunteer, or paid position'

Some - 'I have held at least one co-op, volunteer, or paid position'

Experienced - 'I have over a year's experience working in a role' (does not have to be consecutive)

Professional - 'I have experience working in a skilled role in which I get paid and have benefits'

On a scale of 1 to 5, how confident do you feel in your job search strategy? *

On a scale of 1 to 5, how confident do you feel networking with professionals in your desired field? *

On a scale from 1 to 5, how would you rate your financial literacy (ability to make informed financial plans and decisions)? *

Please list three industries you're interested in, order them according to your preference. *

In what ways do you like those around you to support you towards your goals? *

Words of encouragement

Holding you accountable (checking-in)

Hands-off approach (knowing they're there when I need them)

Advice based on experience

Other:

Required

Tell us a little bit about when you feel like your best self? (Ex. when helping others, when learning something new) *

What do you hope to learn from your Mentor? *

What are three goals you hope to achieve from participating in this program? *

Media Release: From time to time the media may cover events or activities at our programs. This may include local newspapers or other publications. On some of our pages we use photographs and short videos to highlight some of our activities. I hereby authorize Elevate and B-You as follow, and understand that any usage is without remuneration: *

I understand and accept these terms.

I do not accept these terms.

Confidentiality: All client information that is collected by Elevate and B-You is confidential and safe. All personal information is secured and used only by the leadership team, for the sole purposes of assisting you. Your approval is required in writing prior to these discussions taking place. As a client, you have the right not to answer any questions you find to be inappropriate. As a client, you have the right to refuse to have a placement student present during the interview. Any statistical information collected will remain anonymous. *

I understand and accept these term.

I do not accept these terms.

Do you have access to a computer & internet to access virtual events and meetings? *

Yes

Send me a copy of my responses.

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