Company

Which industry you work in:
Select Industry You Work InAgriculture, Forestry, Fishing, and HuntingMiningUtilitiesConstructionComputer and Electronics ManufacturingOther ManufacturingWholesaleRetailTransportation and WarehousingPublishingSoftwareTelecommunicationsBroadcastingInformation Services and Data ProcessingOther Information IndustryFinance and InsuranceReal Estate, Rental, and LeasingCollege, University, and Adult EducationPrimary/Secondary (K-12) EducationOther Education IndustryHealth Care and Social AssistanceArts, Entertainment, and RecreationHotel and Food ServicesGovernment and Public AdministrationLegal ServicesScientific or Technical ServicesHomemakerMilitaryReligiousOther Industry (Please specify below)

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Email

Phone

City

Province
AlbertaBritish ColumbiaManitobaOntarioQuebecNew BrunswickNova ScotiaNewfoundland and LabradorNorthwest TerritoriesNunavut</option>Prince Edward IslandSaskatchewanYukon

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The racial and ethnic group that I identify with is (please select one)*
Select Ethnic GroupBlack (e.g. African Canadian, Caribbean, North American, Black British)East Asian (e.g. Chinese, Japanese, Korean)Hispanic or LatinxIndigenous (e.g. First Nations, Metis, Inuit, Native American, Aboriginal or Torres Strait Islander, Maori)South Asian (e.g. Bangladeshi, Bhutanese, Indian, Nepali, Pakistani, Sri Lankan)Southeast Asian (e.g. Cambodian, Filipino, Indonesian, Laotian, Malaysian, Singaporean, Thai, Vietnamese)Native Hawaiian or other Pacific islanderNorth African or Middle EasternWhite (e.g. European, North America, Pakeha)A racial or ethnic group not listedPrefer not to answer

Another racial and ethnic group that I identify with is (please select one)
Select Ethnic GroupBlack (e.g. African Canadian, Caribbean, North American, Black British)East Asian (e.g. Chinese, Japanese, Korean)Hispanic or LatinxIndigenous (e.g. First Nations, Metis, Inuit, Native American, Aboriginal or Torres Strait Islander, Maori)South Asian (e.g. Bangladeshi, Bhutanese, Indian, Nepali, Pakistani, Sri Lankan)Southeast Asian (e.g. Cambodian, Filipino, Indonesian, Laotian, Malaysian, Singaporean, Thai, Vietnamese)Native Hawaiian or other Pacific islanderNorth African or Middle EasternWhite (e.g. European, North America, Pakeha)A racial or ethnic group not listedPrefer not to answer

Do you identify as a person with a disability?
YesNoPrefer not to answer

Do you identify as 2SLGBTQI+? (The LGBTQI+ acronym refers to Two-Spirited, Lesbian, Gay, Bisexual, Trans, Queer, Questioning, Intersex, Plus other Sexual and Gender Minorities)*
YesNoPrefer not to answer

I have lived in Canada for:*
Less than 5 yearsMore than 5 yearsPrefer not to answer

Why would you like to join The Freshstart Hub's Mentor Program?* (optional)

Pick the date for your session

How did you hear about The Freshstart Hub's Mentor Program?*
The Freshstart Hub InstagramThe Freshstart Hub LinkedInThe Freshstart Hub FacebookThe Freshstart Hub TwitterThe Freshstart Hub PodcastThe Freshstart Hub EventThe Freshstart Hub EmailGoogle SearchI am a returning mentorWord of Mouth (please include who)Partner (please include who)Other (please provide details)

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