Request edit access
Ujima Men's Collective's Protege Project
Protege Project Mentor Application
Sign in to Google to save your progress. Learn more
Name *
Nickname
Address *
Age *
Telephone Number *
Email Address *
Race/Ethnicity *
Race/Ethnicity-Other *
Briefly describe why you want to be a mentor? *
If you agree to become a mentor, you will be asked to agree to the following basic requirements:  To serve as a Mentor, you will be asked to make a minimum commitment of one year with openness to continue in the relationship on a long-term basis. *
To attend a 3 hour of Mentor Orientation and Training before you will be considered for a one-on-one match with a Black same gender loving man. *
To maintain weekly contact with your protege either in person or by phone. *
To maintain monthly phone contact with our Program coordinator the Ujima Men's Collective Protege Project. *
I understand the Ujima Men's Collective reserves the right to accept or decline mentors based on the information gathered. For reasons of confidentiality Ujima Men's Collective will not share this information or reasons of denial with any applicant. *
I agree to be dedicated and dependable in trying to assist my Black same gender loving protege to achieve success in their professional, spiritual, educational and emotional development. *
Please describe any special interests that may be helpful in matching you and your Protege (i.e. stamp collecting, roller skating, computers, football, music, painting, etc.): *
Status *
Please provide a brief biographical sketch. *
Do you agree to have a background check? *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Ujima Mens Collective. Report Abuse