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BCDHA and DHAA Mentorship Program
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BCDHA and DHAA Mentorship Program
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About The Program
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Mentor Profile
Please fill out all required fields.
First Name
*
Last Name
*
Email
*
Province
Select
British Columbia
Alberta
City
*
Select
Abbotsford
Alert Bay
Anmore
Armstrong
Ashcroft
Belcarra
Burnaby
Burns Lake
Cache Creek
Campbell River
Canal Flats
Castlegar
Chase
Chilliwack
Clinton
Colwood
Comox
Coquitlam
Courtenay
Cranbrook
Creston
Cumberland
Daajing Giids
Dawson Creek
Delta
Duncan
Enderby
Fernie
Fort St. John
Fraser Lake
Fruitvale
Gibsons
Gold River
Golden
Grand Forks
Granisle
Greenwood
Harrison Hot Springs
Hazelton
Kamloops
Kaslo
Kelowna
Keremeos
Kimberley
Ladysmith
Lake Cowichan
Langford
Langley
Lions Bay
Lumby
Lytton
Maple Ridge
Masset
McBride
Merritt
Midway
Mission
Montrose
Nakusp
Nanaimo
Nelson
New Denver
New Westminster
North Vancouver
Oliver
Osoyoos
Parksville
Pemberton
Penticton
Pitt Meadows
Port Alberni
Port Alice
Port Clements
Port Coquitlam
Port McNeill
Port Moody
Pouce Coupe
Powell River
Prince George
Prince Rupert
Princeton
Qualicum Beach
Quesnel
Radium Hot Springs
Revelstoke
Richmond
Rossland
Salmo
Salmon Arm
Sayward
Sidney
Silverton
Slocan
Smithers
Surrey
Tahsis
Telkwa
Terrace
Trail
Valemount
Vancouver
Vernon
Victoria
View Royal
Warfield
West Kelowna
White Rock
Williams Lake
Zeballos
Phone
*
Time Zone
[]
Select
(GMT-08:00) Pacific Time (US & Canada)
(GMT-07:00) Mountain Time (US & Canada)
(GMT-06:00) Central Time (US & Canada)
(GMT-05:00) Eastern Time (US & Canada)
(GMT-04:00) Atlantic Time (Canada)
(GMT-12:00) International Date Line West
(GMT-11:00) Midway Island, Samoa
(GMT-10:00) Hawaii
(GMT-09:00) Alaska
(GMT-08:00) Pacific Time (US & Canada)
(GMT-08:00) Tijuana, Baja California
(GMT-07:00) Arizona
(GMT-07:00) Chihuahua, La Paz, Mazatlan
(GMT-07:00) Mountain Time (US & Canada)
(GMT-06:00) Central America
(GMT-06:00) Central Time (US & Canada)
(GMT-06:00) Guadalajara, Mexico City, Monterrey
(GMT-06:00) Saskatchewan
(GMT-05:00) Bogota, Lima, Quito, Rio Branco
(GMT-05:00) Eastern Time (US & Canada)
(GMT-05:00) Indiana (East)
(GMT-04:00) Atlantic Time (Canada)
(GMT-04:00) Caracas, La Paz
(GMT-04:00) Manaus
(GMT-04:00) Santiago
(GMT-03:30) Newfoundland
(GMT-03:00) Brasilia
(GMT-03:00) Buenos Aires, Georgetown
(GMT-03:00) Greenland
(GMT-03:00) Montevideo
(GMT-02:00) Mid-Atlantic
(GMT-01:00) Cape Verde Is.
(GMT-01:00) Azores
(GMT+00:00) Casablanca, Monrovia, Reykjavik
(GMT+00:00) Greenwich Mean Time : Dublin, Edinburgh, Lisbon, London
(GMT+01:00) Amsterdam, Berlin, Bern, Rome, Stockholm, Vienna
(GMT+01:00) Belgrade, Bratislava, Budapest, Ljubljana, Prague
(GMT+01:00) Brussels, Copenhagen, Madrid, Paris
(GMT+01:00) Sarajevo, Skopje, Warsaw, Zagreb
(GMT+01:00) West Central Africa
(GMT+02:00) Amman
(GMT+02:00) Athens, Bucharest, Istanbul
(GMT+02:00) Beirut
(GMT+02:00) Cairo
(GMT+02:00) Harare, Pretoria
(GMT+02:00) Helsinki, Kyiv, Riga, Sofia, Tallinn, Vilnius
(GMT+02:00) Jerusalem
(GMT+02:00) Minsk
(GMT+02:00) Windhoek
(GMT+03:00) Kuwait, Riyadh, Baghdad
(GMT+03:00) Moscow, St. Petersburg, Volgograd
(GMT+03:00) Nairobi
(GMT+03:00) Tbilisi
(GMT+03:30) Tehran
(GMT+04:00) Abu Dhabi, Muscat
(GMT+04:00) Baku
(GMT+04:00) Yerevan
(GMT+04:30) Kabul
(GMT+05:00) Yekaterinburg
(GMT+05:00) Islamabad, Karachi, Tashkent
(GMT+05:30) Sri Jayawardenapura
(GMT+05:30) Chennai, Kolkata, Mumbai, New Delhi
(GMT+05:45) Kathmandu
(GMT+06:00) Almaty, Novosibirsk
(GMT+06:00) Astana, Dhaka
(GMT+06:30) Yangon (Rangoon)
(GMT+07:00) Bangkok, Hanoi, Jakarta
(GMT+07:00) Krasnoyarsk
(GMT+08:00) Beijing, Chongqing, Hong Kong, Urumqi
(GMT+08:00) Kuala Lumpur, Singapore
(GMT+08:00) Irkutsk, Ulaan Bataar
(GMT+08:00) Perth
(GMT+08:00) Taipei
(GMT+09:00) Osaka, Sapporo, Tokyo
(GMT+09:00) Seoul
(GMT+09:00) Yakutsk
(GMT+09:30) Adelaide
(GMT+09:30) Darwin
(GMT+10:00) Brisbane
(GMT+10:00) Canberra, Melbourne, Sydney
(GMT+10:00) Hobart
(GMT+10:00) Guam, Port Moresby
(GMT+10:00) Vladivostok
(GMT+11:00) Magadan, Solomon Is., New Caledonia
(GMT+12:00) Auckland, Wellington
(GMT+12:00) Fiji, Kamchatka, Marshall Is.
(GMT+13:00) Nuku'alofa
Years of Practice
*
Select
New Grad (under 1 year)
Early Career (1 to 5 years)
Mid Career (6 to 15 years)
Late Career (20+ years)
I am practicing as a:
*
Select
Certified Dental Assistant (CDA)
Registered Dental Hygienist (RDH)
Dental Hygiene Practitioner (DHP)
Dental Therapist (DT)
Volunteer experience
*
I am trained as a
(
click all that apply
)
*
Certified Dental Assistant (CDA)
Registered Dental Hygienist (RDH)
Dental Hygiene Practitioner (DHP)
If other:
Mentorship Interest (check all that apply)
CDA leadership (only for CDA)
Clinical practice
Education (only for DH)
Independent dental hygiene practice (only for DH)
Interprofessional collaboration
Leadership (only for DH and DT)
Long-term care
New graduate or early career
Other
Public health (only for DH/DT)
If other:
Gender:
Select
Male
Female
Prefer not to say
Other
Pronouns (Optional)
Language other than English
Communication preference (check all that apply)
Email
Facetime
Other
Phone
Teams
Whatsapp
Zoom
Meeting frequency preference
*
Select
Weekly
Monthly
Other
If other:
*
Delivery preference
*
Select
Virtual delivery
In-person delivery
Either virtual or in-person delivery
How many mentees would you like to mentor?
*
Select
1
2
3
4
What are your favourite hobbies or activities (please tick all that apply!)
Board games / card games
Cars / vehicles
Concert going
Cooking/baking
DIY and arts & crafts
Doing sports and fitness
Gardening
Going to the movies
Listening to music
Live theatre / shows
Making music / playing an instrument
Meditation / wellness
Netflix shows
Other (please specify)
Outdoor activities (hiking, walking, etc.)
Pets
Photography
Reading fiction
Reading non-fiction
Skiing / Snowboarding
Socializing / Bars & Clubs
Spending time with family
Tech / Computers
Traveling
Video games
Watching sports live
Watching sports on TV
Writing
If other:
Password
must be between
8 and 20 characters
Password Confirm
Security questions
I went to high school in this city:
*
My first car was a:
*
My favourite colour is:
*
Mentoring agreement
Disclaimer: commitment of at least 2 hours per month
I agree to the
Mentorship Agreement
I agree to the
Privacy Policy
I agree to the
Code of Conduct
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