Trans Mentorship: Trans Mentee Application
Any transgender client wanting to enter into our TransMentor Program as a mentee is to fill out this intake form. ::DISCLAIMER:: **The volunteer mentors are peer mentors and are NOT licensed medical or mental health professionals. Their thoughts and opinions are their own and do not necessarily represent those of Trans Empowerment Project. Any opinions/advice/suggestions/thoughts/etc. of any Mentor do NOT have to be taken or followed at all. If you feel that your mentor is acting inappropriately or have any issues whatsoever, you are free to contact James.Blake@transempowermentproject.com for assistance.**
Email address *
Name *
Date of Birth *
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Phone
Please include at least one contact method
Email
Please include at least one contact method
Preferred Contact Method *
City & State *
*Although our program is an online based program, we do try to choose someone in close proximity to your location for a potential match-up; n the event the two of you would like to meet in person for the mentorship.
Please provide two emergency contacts with contact info: *
How did you hear about the TransMentor Program?
Have you ever been in a mentor program before?
What do you hope to gain by joining this program?
What does being a "safe person" mean to you?
What is your definition of a "safe space"?
What is your definition of intersectionality? *
Please list one or more goals you would like to achieve related to transition: *
Please list one or more goals you would like to achieve related to education or employment: *
Please list one or more personal goals you would to achieve: *
What is your idea of a positive mentorship? *
Do you have any religious preferences you would like us to keep in mind when matching you to a TransMentor?
Do you have any allergies, such as to animals we should know about when matching you to a TransMentor?
Have you had any mental health concerns in the past 6 months? *
If yes, please explain:
Do you have any supportive family members?
Do you know any other transgender people?
Have you have any suicidal thoughts in the last 6 months? *
Are you currently feeling like ending your life? *
Have you ever been convicted of a crime? If yes, explain: *
We have two types of mentors available as an option, one may be a cisgender ally (such as: the parent of a trans child). Are you comfortable also having an ally available to you as a mentorship option? Please explain: *
Do you have any criminal background we should be aware of such as: misdemeanors, felonies, or capital offenses? *
If yes, please explain here: *
*If "no" above please input: "N/A"
Do you consent to a background check? *
A copy of your responses will be emailed to the address you provided.
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This form was created inside of Trans Empowerment Project.