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Mentee Application
Please complete the information requested below. Your answers will assist us in
matching you with a mentor and opportunity that fits your skills, interests, and availability.
Thank you for your time and assistance in making Empowering Leaders
a quality program for
all!
*
= required field
* Indicates required question
First name
*
Your answer
Last name
*
Your answer
Address
*
Your answer
City
*
Your answer
State, Zip code
*
Your answer
Preferred email address
*
Your answer
Preferred phone number
*
Your answer
Employer if applicable
*
Your answer
Emergency Contact Name
*
Your answer
Emergency Contact Phone Number
*
Your answer
Emergency Contact Relationship
*
Your answer
Ethnicity
*
African American
American Indian/Alaskan Native
Asian
Asian/Pacific Islander
Other Pacific Islander
Caucasian
European American
Hispanic
Latino
Multi-Racial
Native American
Other
Gender
*
Cis-male
Trans male
Cis-female
Trans female
Non-binary
Non-conforming
Genderqueer
Prefer to self describe
Prefer not to answer
Identify as LGBTQIA+
*
Yes
No
Required
Birthdate
*
MM
/
DD
/
YYYY
I am under 18 years of age
*
Yes
No
What MN Community or Technical College are you currently attending?
*
Your answer
What position are you currently serving as? (GC, PC, Cabinet positions, Senate member)
*
Your answer
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