Skip to content
  • About Us
    • Our Mission
    • Our Team
    • Fellow Members
    • Staff
    • Job opportunities
  • Partnership Opportunities
    • Partnerships Application
  • Become a Member
    • Associate Fellow Registration
    • Fellow Application
  • Already a Member
  • Events
  • Contact Us
  • FR

Patient, Family, & Mental Health Professional Advisory Committee Application Form

"*" indicates required fields

Application Form

Name*
Geographic Region*
I would like to participate in this committee as (you may select more than one):*

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, Associate Fellows members, and applications. 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?*
I self-identify as:*
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?*
D. What is your gender identity?*
(Trans* includes, for example trans, transgender, transsexual, transwoman, transman)
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+?*
F. Socioeconomic disadvantage is being tracked by DIVERT Mental Health, to help provide access to the ‘academia hidden curriculum’ that trainees and early career investigators often report not knowing because they were not raised in Canada or were raised in family environments that did not transmit this information. Please check all that apply*
DD slash MM slash YYYY
DIVERT Mental Health
2006 Sherman Health Science Research Centre
281 Ian MacDonald Blvd
York University
Toronto, Ontario M3J 3M4
416 736 2100 ext. 20177
  • Twitter
  • LinkedIn
  • Instagram
  • About Us
  • Partnership Opportunities
  • Become a Member
  • Already a Member
  • Events
  • Contact Us
  • FR

© 2025 DIVERT Mental Health. All Rights Reserved