Crown Ward Mentorship Registration

Mentee Registration Form​​​​​

Required fields are marked with an asterisk (*)

Personal Information

My preferred form of communication:
*Please note: The majority of communication about the mentorship program will be sent using your preferred method of communication

Emergency Contact Information

(i.e. guardian, CAS worker)

What are your Interests?

We want to know what you like to do and what your interests are so that we can create some fun and engaging activities for you.
Please select all your interests


More About You

Nipissing University and the Crown Ward Mentorship Program is committed to accessibility for persons with disabilities. Please contact us if you have any particular accessibility requirements.
Contact: Crown Ward Mentorship Program, or call 474-3450 ext. 4241.