Associate Fellow Registration – DIVERT Mental Health

Why Should I be a DIVERT Mental Health Associate Fellow?

To access our online platform, you must be an associate member. DIVERT is committed to serving diverse communities. We can’t achieve our mission if we don’t know who is part of our DIVERT community.

You can join anytime, day or night! It only takes 3-5 minutes. Once you complete the form, you are automatically admitted.

Associate Fellow members are automatically provided with credentials to login to our Learning Management System. This is where you will be able watch, learn, and evaluate all of DIVERT’s content in either English or French, live or archived. If you register on the day of a live event, we will do our best to track requests and send login credentials in time for the event.

If you have any questions about the registration process, please contact divert@yorku.ca.

The completed contact form (see below)
The completed voluntary self-identification form (see below)
The Associate Fellow Commitment Form (see below)

Registration

"*" indicates required fields

Application Form

Name*

First Last

Email*

Institutional/Organizational Mailing Address*

Street Address Address Line 2 City Province Postal Code Country

Date of Registration*

University or Organization*

Geographic Region of your University or Research Institute*

North (Yukon, Northwest Territories, Nunavut)

West (British-Columbia, Alberta, Saskatchewan, Manitoba)

Central (Ontario)

Central (Québec)

East (Nova-Scotia, New Brunswick, Prince-Edward Island)Newfoundland and Labrador)

Outside of Canada

Preferred Language of Instruction*

Preferred Pronouns*

As you selected 'Other', please specify your preferred pronouns:*

What sector do you most identify with?*

Are you a Post-Degree Health/Mental Health Professional?*

How senior are you in your career?

What discipline do you most identify with?

As you selected 'Other', please specify:*

Self-identification Form

DIVERT Mental Health is committed to creating practices that promote the importance of equity, diversity, and inclusion. Our strength as an organization is linked to diversity and inclusivity of our membership and this depends on our ability to know this information about our members. We will constantly strive to uphold your trust to share this information. If you have questions, please reach out to divert@yorku.ca.

This request form is a mandatory requirement for DIVERT Fellows and Associate Fellows members. However, if you do not want to provide information about one or more aspects of your identity, please check “I prefer not to answer” to submit the form.

Purpose and Use: We will use this data to create innovative ways to support and welcome the participation of individuals who identify with any of the federally designated equity-seeking groups (Women, Racialized, Indigenous Peoples of Canada, Persons with Disabilities] and other groups who have been traditionally marginalized (e.g. 2SLGBTQIA+, prolonged lived experience with poverty) in the mental health system/mental health training. There will be tailored or targeted opportunities to individuals with certain lived experiences, and we will use your data to invite you to these experiences (but you have the right to ask us to stop). We will never present your data individually and it will always be reported in aggregate form (anonymized).

Privacy and Confidentiality: DIVERT will follow strict security practices and procedures required to ensure that your self-identification data will not be compromised. As such, all received data will be stored securely and only authorized personnel (i.e., the DIVERT Mental Health Program Manager and Nominated Principal Investigator) will be able to access your self-identification data. On occasion, when approved by the Administration and Management Committee, the Co-Chairs of other core DIVERT Mental Health Leadership Committees will be given permission. You have the right to withdraw your self-identification data at any time.

A. Indigenous Peoples within the geopolitical state of Canada identify as First Nation, Inuit or Métis. Based upon this definition, do you self-identify as Indigenous?*

Yes – Indigenous Peoples of Canada

Yes – But not living in the geopolitical state of Canada

I prefer not to answer

I self-identify as:*

First Nations

Métis

Inuit

B. How do you identify your race/identity/ethnicity?*

C. Persons with different abilities are those that have a long-term or recurring physical, mental, sensory, psychiatric or learning impairment and: (a) who consider themselves to be at a disadvantage in employment by reason of that impairment, or (b) believe that an employer or potential employer is likely to consider them to be disadvantaged in employment by reason of that impairment. This also includes persons whose functional limitations owing to their impairment have been accommodated in their current job or workplace. Based upon this definition, do you self-identify as a person with a disability?*

Yes

I prefer not to answer

Is there anything DIVERT Mental Health can do to help accommodate your participation in our virtual or in-person activities?

D. What is your gender identity?*

Woman

Man

Trans*

Two-Spirit

Intersex

Gender Non-conforming

I prefer not to answer

Other

(Trans* includes, for example trans, transgender, transsexual, transwoman, transman)

As you selected 'Other', please specify:*

E. 2S/LGBQA+ is an acronym for persons who identify, for example as, two-spirit, lesbian, gay, bisexual, genderqueer, questioning, or who otherwise express sexual orientation diversity. Do you self-identify as 2S/LGBQA+?*

Yes

I prefer not to answer

F. Socioeconomic or social stress or disadvantage is being tracked by DIVERT Mental Health, for those who choose to identify these factors in their lives. People may choose to identify these factors because they have caused marginalization in their day-to-day lives and these variables may not be tracked in usual diversity metrics. This information will help us create programming that better suits the needs of our community. Please check all that apply*

I am a first generation Canadian

I came to North America because I or my family was claiming asylum or refugee status

I have lived experience with poverty (e.g., periods of time with food insecurity, personal or familial income that did not allow for safe housing, healthy food, health care)

I am from a religious group (e.g. identifying with a religious group that may be subject to criticism, stigma, bias, or other threats)

Other types of disadvantages we have not asked you about

I prefer not to answer

N/A

Please specify other types of disadvantages that we have not asked you about

Commitment

Commitments of Associate Fellow Members

Applicants who wish to become Associate Fellows members are asked to make the following commitment:

To fill out a brief evaluation during each online learning event you attend.

Full Name*

Date*

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