Mentee Application
This application is for all people wishing to be connected with a Kyler's Konnections' Mentor.
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 *
If you listed "social media" or "other" above, please give contact information
Your answer
Legal Name (if different)
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 Snapchat, what is your user name?
Your answer
If you use Instagram, 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
If you use Tumblr, what is your profile name?
Your answer
If attending school, which school?
Your answer
Please describe why you would like a mentor *
Your answer
What challenges do you foresee? *
Your answer
What are your interests/hobbies? *
Your answer
Are you currently out to your parents?
Are you currently physically and mentally healthy? (PLEASE NOTE: answering NO to this question does NOT disqualify you for this program. This question is used to better match you with a mentor) *
If you are not currently physically and/or mentally healthy, please explain (used for purposes of matching you with a mentor)
Your answer
Describe your support system (parents, friends, school, etc.). *
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 the child of an active service member of the U.S. Military?
Are you the child of a U.S. Military veteran?
What traits are important to you when being matched with a mentor (age range, location, job, school, interests, etc.)? *
Your answer
If your life were a quote, what would that quote be (could be from yourself or someone else)? *
Your answer
What else would you like us to know about you?
Your answer
If you are a minor, do you have at least one parent/guardian who will sign their consent to meet with a mentor? IF NOT, PLEASE CONTACT WILL WILLIAMS AT WILLOLIVERWILLIAMS@GMAIL.COM.
A copy of your responses will be emailed to the address you provided.
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