Mentor Application
Trans Peer Mentor Program
First and last name
Pronouns
Date
/
Month
/
Day
Year
Date
Email address
example@example.com
Cell phone
Address (#, City, State, Zip)
Able to attend mandatory monthly mentor meetings in Oakland on the 2nd Sunday of the month? (yes or no)
Gender Identity
Sexual Orientation
Ethnicity
Age
Religion/Spirituality
Hobbies
Other identities you'd like to share:
What gender were you assigned at birth?
Transportation you will use (Lyft, public transportation, etc.):
Accessibility needs (stairs alternative, scent free, etc)
Any additional information you'd like to share:
How did you hear about the Trans Peer Mentor Program?
Why do you want to be a mentor?
What past experiences qualify you to mentor others? (Please describe any relevant work or volunteer experiences you have had. Note readings you have done or groups, workshops, courses or activities you have attended etc.)
What personal qualities do you possess that would help you mentor others?
What topics regarding social transition do you feel able to provide insight and guidance on, based on personal experience?
Chosen Name
Chosen Pronouns
Legal Name Change
Legal Gender Marker Change
Bathroom Use
STP's
Style/presentation
"Coming Out"
Choosing not to "come out" or be visible
Uncertainty around decisions
What topics regarding medical transition do you feel able to provide insight and guidance on, based on personal experience? (trigger warning: surgeries)
Bottom Surgery
Top Surgery
Hormone Replacement Therapy
Voice Training
Hair Removal
Detransitioning
Stopping Hormones
Choosing not to pursue medical changes
Uncertainty around medical changes
Submit
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