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Mentee Intake Form 
If you are a high school or college student with a disability who is interested in connecting with a college student mentor to learn more about navigating a disability in college or disability advocacy, you have come to right place. Please take a few minutes answer the questions below so that can help you figure out how we can best assist you in your journey in higher education.

Once you fill out this form, you will be emailed by aplaceforusnetwork@gmail.com to set up a meeting with one our staff members so that we can go over next steps and set up with one our awesome mentors! 

For more information, visit https://aplaceforusdisability.org or contact aplaceforusnetwork@gmail.com 

If you are curious how a meeting your mentor may go, please check out this Example Mentor Meeting. 

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Email *
Preferred name  *
Phone Number  *
Where are you from?
What are your current needs/concerns/fears in regards to higher education and/or your disability?
How could we best help you in your journey of succeeding in higher education?
What kind of college/university are you currently attending or applying to? (Please indicate location, size or specific school if you know)
What are you interests?
What is your disability if comfortable sharing? 
Please set a virtual call with a representative at A Place For Us to discuss your needs further, using this link: https://calendly.com/aplaceforusnetwork/30min. Did you schedule a meeting with us?  *
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