Thank you for your interest in our programs. Please note that this is NOT an application form. This form is to request an intake PRIOR to being requested to fill out an application form. Once you submit this form you’ll be contacted by a staff person.

  • Parent/Guardian Information


  • (first and last)

CRITERIA (Please click to expand this section)



For Virtual Mentoring youth can be between 9-17 years old.

Youth must voluntarily want to be a part of the program and have the ability to use the internet, smartphone/tablet/computer somewhat independently.

Youth must have a parent/guardian who supports the application and can be involved in the process. Youth who are over 16 will be assessed as the primary applicant, should they wish to advocate for themselves. If you are not the individual with legal signing rights for the child, the legal signatory must provide permission.

Youth, and parent/guardians if applicable, must agree to regular contact with the Agency.

Youth must reside in Winnipeg

If parent/youth are interested in one of the other programs eventually, they must meet the criteria for those programs also.

An Enrollment Coordinator will work with you and your child to review your situation and determine how a mentor would be of benefit. Factors that would be considered regarding your child’s needs include:

  • Parent or guardian support
  • Adult involvement other than the parent(s) or guardian(s)
  • Peer relationships
  • School performance
  • Involvement in community activity
  • Living environment
  • Mental health needs
  • Ability to form and maintain a healthy, safe relationship
  • Ability to perform self-care