LGBTQ+ R.I.S.E Mentorship Application
All interested mentees and mentors please fill out this questionnaire. Eligibility and pairing will be based on your responses. If you need any assistance filling out this form, please email risementorshiphelp@gmail.com
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Format: (000) 000-0000.
Age
*
18-29
30-49
>50
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Email
*
example@example.com
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Background and Personal Information
Education (check the highest degree achieved)
*
Bachelors Degree
Some college
Highschool
Other
Are you interested in being a mentor (person giving mentorship) or a mentee(person receiving mentorship)?
*
Mentor
Mentee
What professional field would you like to offer mentorship in?
*
Please Select
Culinary Arts
Business
Finance
Education
Engineering
Information Technology
Other
What professional field would you like to receive mentorship in?
*
Please Select
Culinary Arts
Business
Finance
Education
Engineering
Information Technology
Other
If you selected other for your professional field of interest, please type your field below.
Do you have a resume you would like to share with us?
*
Yes
No
Please upload your resume here.
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Can you briefly explain your professional history and current work?
*
Do you have any mentorship experience?
*
yes
no
Can you please explain a bit about your mentorship experience?
*
Are you able to offer at least 6 hours a month towards the mentorship program?
*
Yes
No
How would you describe your personality?
*
Please Select
I keep to myself.
I talk to people sometimes.
I tend to talk to people often.
I am very outgoing.
When you think about communicating with your mentor/mentee, how do you envision the relationship?
*
More casual – we will contact each other when we want to talk, knowing that the other person will be available for me when needed.
More structured – we will schedule phone calls, e-mails, or personal meetings to ensure we keep up with one another.
Would you be attending this mentorship virtually or in person?
*
Virtually
In Person
Both
Tell us how you heard about this program
Briefly explain why you would like to be a part of this mentorship program?
*
Please add any additional information here.
Please verify that you are human
*
Submit
Should be Empty: