Mentor Application
This application is for all adults wishing to be a Kyler's Konnections Mentor.

You may choose whether or not to answer on all questions regarding your identities outside of being trans/gender nonbinary. These are gathered for the purpose of getting a better understanding of the community we are serving and for grant writing. Many grants require knowing more about the demographics we serve and whether or not their mission also serves similar intersections to community such as race, economic class, and family size.

Email address *
Name *
Your answer
Gender Identity *
Your answer
Pronouns *
Your answer
Date of Birth *
Your answer
Are you Hispanic or Latine/x?
Race
Phone Number *
Your answer
Email address *
Your answer
Street Address *
Your answer
City *
Your answer
Preferred method of contact (choose one) *
When did you start your transition? *
Your answer
Have you been integrated into the world with this identity for at least one year? *
Please list your legal name (if different) any previous last names used for background check purposes
Your answer
Which social media sites do you use (choose all sites where you have a public profile)
If you have a Facebook page, what name(s) are listed?
Your answer
If you have a Twitter account, what is your user name?
Your answer
If you use Instagram, what is your user name?
Your answer
If you use Snapchat, what is your user name?
Your answer
If you use Tumblr, what is your user name?
Your answer
If you have a YouTube Channel, what name(s) are listed?
Your answer
If you listed OTHER, list sites and contact/profile information
Your answer
Current employer/school
Your answer
Profession/major
Your answer
Please describe why you feel you are qualified to be a mentor *
Your answer
In your role as a mentor, what challenges do you foresee? *
Your answer
What are your interests/hobbies? *
Your answer
Describe your support system. *
Your answer
How many people (including yourself) make up your household?
Your answer
What is your household's annual income before taxes?
Does your family have a female head of household?
Are you currently physically and mentally healthy? *
If you are not currently physically and/or mentally healthy, please explain
Your answer
Are you an active service member of the U.S. Military?
Are you a veteran of the U.S. Military?
Are you the child of an active service member of the U.S. Military?
Are you the child of a U.S. Military veteran?
What is your education level?
Describe any experience you have had working in a leadership or mentorship role. *
Your answer
In what area of San Diego County do you wish to mentor? *
Your answer
List any LGBTQ+ organizations/clubs/support groups that you are currently involved with
Your answer
Have you ever been involved in any LGBTQ+ organizations/clubs/support groups not listed above? If so, please list.
Your answer
When you went through your own personal journey, what would have helped you? *
Your answer
If your life were a quote, what would that quote be (could be from yourself or someone else)? *
Your answer
Do you consent to allow TransFamily Support Services and/or Kyler's Konnections to use any photos?
Do you consent to allow TransFamily Support Services and/or Kyler's Konnections to share your contact information with other mentors?
What else would you like us to know about you?
Your answer
List three personal references that we may contact (name, phone, email address)
Your answer
Do we have your consent to perform a background check?
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service