Please provide the following contact information:

First name
Last name
Work Phone
Home Phone
E-mail

So that we can try to match you with student(s) of similar interests please also answer the following questions:

Your Age
Your Sex	Male Female

What are your interests/hobbies?

Present occupation   

Is English your native language?            Yes    No  

Are you a Canadian citizen?                   Yes    No  

Are you available to meet with your student(s) weekday evenings?          Yes       No  

Are you available to meet with your student(s) on weekends?                 Yes    No  

Please enter any additional questions or comments here. . .

When are you available to begin?   

Where did you learn about the ACCESS Canadian Buddy Program?