Request for Student Ally

REQUEST FOR STUDENT ALLY

Thank you for your interest in the Student Ally program! Our Student Allies can assist you with your transition into university.

This application helps us to find the best possible Ally-SAS Student match.

Please submit completed form to – or contact us should you have any questions.

BASIC INFORMATION

First Name: / Preferred First Name: / Last Name:
Address: /  On Campus
McMaster Email: / Alternative Email:
Phone: / Preferred Method of Contact: /  McMaster Email  Alt Email  Phone
Languages Spoken: / Gender: / Birthdate (exclude year):
Preferred Pronoun:

EDUCATIONAL BACKGROUND

Student Number: / Faculty:
Program: / Year of Study (for this Sept):
SAS Program Coordinator:

DISCLOSURE

It is suggested (but not required) that a student disclose their nature of their disability to their Ally in order to assist Ally in providing specialized assistance. Please choose an option you most prefer:

 I would like my diagnosis disclosed AND  I will inform my Ally OR  I would like the Transition Coordinator to inform my Ally

 I do not want my diagnosis disclosed

 I do not want my diagnosis disclosed but will allow the Transition Coordinator to share the following information with my Ally:

MATCH PREFERENCES AND INTERESTS

Please specify some personal interests to help us better match (sports, favourite TV/movie, arts, etc.)
Are you interested in intramurals offered by David Bradley Athletic Centre? If so, please specify.
Would you like to be matched with someone in the same faculty as you? Please note this may not be possible, however we will try our best should you want someone from the same faculty. /  Yes
 No
 No preference
Are you open to working with all genders? If no, would you prefer to be matched with someone of the same gender? /  Yes, any gender
 No, same gender
Please check off the areas you’d like to learn more about with an ally:
Skills Development / Campus/SAS Navigation / Social
 Study skills
 Time management
 How to use McMaster website (MOSAIC, Avenue to Learn, etc.)
 How to speak with professors /  Navigating campus
 Available services and locations on campus
 Bus routes
 Library use
 Finding a tutor
 Accessing scholarships and bursaries /  Connecting with student clubs and committees
 Getting involved in athletics/recreation
 Community engagement – what’s available off campus
 Attending events with Ally
OTHER:
Please rank (with 1 being most) the areas you’re most interested in / ____ Skills Development
____ Campus/SAS Navigation
____ Social

COMMITMENT AND AVAILABILITY

How long would you like support? /  Fall (Sept – Dec)  Winter (Jan – April)
 Fall and Winter (Sept – April)
How often would you like support? /  Weekly  Biweekly
 Monthly  Other ______
Availability (if known at time of application – this can be updated once timetables are released)
MON / TUES / WED / THURS / FRI / SAT / SUN
Mornings /  /  /  /  /  /  / 
Afternoons /  /  /  /  /  /  / 
Evenings /  /  /  /  /  /  / 

I have read and understood the information given here about the Student Ally program. I agree/understand that:

All the information I provided is true and will be used when matching a Student Ally with me
During the matching process, that information on this form may be shared with my Student Ally. I understand that all Student Allies are governed by a confidentiality agreement
Being matched with a Student Ally fitting all my preferences and/or criteria cannot be 100% guaranteed
I must abide by all policies of the Ally program (only meeting on campus, contact only during working hours, communicating with the Transition Program Coordinator when issues/concerns arise)
If there are any reasons that I cannot continue in this program, I will notify my match and the Transition Program Coordinator

Signature: ______Date: ______