Application for Partnership – Schools & Agencies Step 1 of 4 - Organization Information 0% Thank you for your interest in becoming involved with the Alberta Mentoring Partnership (AMP). Please review and complete the below Application and submit it to AMP. Please note there are two ways to get involved with AMP: AMP Agencies or Schools – are community organizations and schools that are running direct mentoring programs, formally or informally. AMP Builders – support the vision and mission of AMP, through advocacy and shared resources. This is the application to become an AMP Agency or School. Tools, guides, and sample documents are available on the following websites to support you in building a quality mentoring program: albertamentors.ca www.mentoring.org Should you have questions or require further support to fulfill the criteria, please contact AMP. We are happy to support the great work you are doing in the mentoring field.Name*Please enter the name of the individual filling out this application. First Last Email Organization InformationLegal name of organization/school* Is Your Mentoring Program in a School or a Community Agency?*Community AgencySchoolOffice Phone*FaxWebsite FacebookYour Agency or School Facebook PageTwitterYour Agency or School Twitter Page.InstagramYour Agency or School Instagram Page.Office E-Mail*Note: This e-mail will be used as your contact e-mail on your partner profile page. Organziation LogoIf you have a logo for your organization - please upload it so that it can be displayed on our website.Accepted file types: jpg, gif, png, pdf.Mailing address*City*Province*AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukonPostal Code* Organization/School ContactPosition*The position of your organization contact.Select OneExecutive DirectorGeneralCommunity ProgramsFund DevelopmentMarketing/CommunicationsCommunity InvestmentSchool PrincipalOtherPosition Other*You answered other to your position. Please type in your position title.Name*Please enter the first and last names of the main contact for your organizationTitleSalutationMr.Mrs.Ms.MissDr.Rev.Hon.Phone*Please enter the main phone number for your organizations main contact.FaxCellEmail* Preferred method of contactEmailPhone Organization DetailsScope of organization*Select OneProvincialCanadian RockiesAlberta SouthAlberta CentralAlberta NorthCalgary and AreaEdmonton and AreaOrganization Description*Provide a brief description of your organization/agency/school and the region(s)/populations you serve for your online AMP profile.Programs & Services Offered*Provide a brief description of the programs you deliver to children and youth, as well as any other relevant information, for your online AMP profile.Area of core focus*Identify the models your organization uses to deliver mentoring programs (check all that apply) Peer mentoring (same or similar age) One-to-One Mentoring Group Mentoring Cross-age Mentoring (eg. high school student with elementary student; senior with teenager) E-mentoring In School Mentoring (Schools will think that all mentoring is in school mentoring) Informal Formal Other Other Areas of Core Focus:*You selected "Other" as an area of core focus. Please insert any other areas of core focus here.Please identify the children and youth your organization/school serves:Ages*Check all that apply 0-4 5-10 11-15 16-18 18-24 Please identify any special populations your organization servesCheck all that apply Children/Youth in Care Aboriginal Children/Youth Children/Youth with a Disability Rural/Remote Immigrant Children/Youth Sexual Minority Children/Youth Girls/Women Boys/Men Other Which Other special populations does your organization serve?*Approximately, how many youth does your organization provide mentoring to annually?How did you hear about the Alberta Mentoring Partnership?*Why are you applying to become an Alberta Mentoring Partnership Agency or School?*How can the Alberta Mentorshing Partnership best support your organization/school and mentoring initiatives?* AMP Agency / School Checklist*PLEASE READ THE FOLLOWING CAREFULLY AND IF YOU ARE AGREEABLE, PLEASE INDICATE YOUR AGREEMENT TO THE FOLLOWING TERMS BY CLICKING “I AGREE” WHERE APPLICABLE: I verify that my organization has authorized and approved the submission of this information and desires to work with the Alberta Mentoring Partnership to support children and youth in Alberta. I understand that the information provided in this submission may be published on the Alberta Mentoring Partnership website or in their promotional materials. Upon approval as a partner of the Alberta Mentoring Partnership (“AMP”), and in consideration of such approval and the services, tools, opportunities and resources made available as a result of such approval, my organization/agency/school represents, warrants, acknowledges and agrees as follows : My organization/agency/school is directly operating a mentoring program for children and youth. My organization/agency/school is aware that AMP does not assess or evaluate the quality or effectiveness of programing provided by Agencies and therefore the title of Agency indicates engagement with AMP and is not a credential indicating quality mentoring. My organization/agency/school will advocate for and support the vision and mission of AMP. My organization/agency/school has authorized and approved the submission of this document. AMP is not a legal entity, a legal partnership or a joint venture. The representations, warranties, acknowledgments and agreements made by my organization/agency/school are made to and with the entities and persons associated with AMP. Approval as a partner of AMP does not create any legal relationship of partnership, joint venture or agency between my organization/agency/school and any entity or person associated with AMP, and my organization/agency/school has and will have no power or authority to act for or bind any entity or person associated with AMP by reason of its approval as a partner of AMP. At any time and for any reason whatsoever, the services, tools, opportunities and resources associated with AMP may be made unavailable to my organization/agency/school, and my organization’s/agency’s/school’s status as a partner of AMP may be termination, notwithstanding its prior approval as a partner of AMP. My organization/agency/school has the legal right to use, publish, and authorize the publication of, any logos, photos and other visual or written materials submitted in or with its application to be approved as a partner of AMP (the “Materials”). My organization/agency/school hereby authorizes and permits use and publication of any of the Materials on the AMP website and in any AMP promotional materials. AMP accepts no responsibility for its use or publication of the Materials. My organization/agency/school is, and will remain, solely responsible for ensuring that any use or publication of the Materials on the AMP website or in any AMP promotional materials will not infringe or violate any other party’s intellectual property rights or interests in, or related to, the Materials. My organization/agency/school will fully indemnify and hold harmless all other entities and persons in any way associated with AMP against any and all claims or proceedings that may be made or commenced against them in any way connected to my organization’s/agency’s/school’s operation of any mentoring program or in any way connected with any use of or publication of any of the Materials. The indemnity will cover full solicitor and own client costs and disbursements incurred by any entity or person associated with AMP as a result of any such claims or proceedings. I have the authority to warrant, represent, acknowledge and agree to the foregoing on behalf of my organization/agency/school, and in so doing, I bind my organization/agency/school. I AGREE Submitted by*Please type your name.Submission date*Please choose todays date. Date Format: MM slash DD slash YYYY Once received, the Alberta Mentoring Partnership will review your application and notify you of acceptance.CAPTCHANameThis field is for validation purposes and should be left unchanged.