Health Core Mentor Application
Please complete this form so we can learn more about you and follow up after the mixer.
Full Name *
Your answer
Occupation & Company *
Your answer
Email Address *
Your answer
Phone Number (best for contacting you) *
Your answer
Any other community & professional affiliations
Your answer
Why do you want to be a mentor? *
Your answer
Have you ever been a mentor or a mentee? Or, have you ever had to form a professional relationship with a youth? If so, please tell us about it. *
Your answer
Are you able to commit to at least 2 dinners with your mentee this summer? (Both dinners within a group setting) *
Your answer
Do you have any experience with youth ages 17-24? *
Your answer
Do you have any experience with youth who have experienced trauma? *
Your answer
Do you have experience with talking about issues and problems relating to race and racism? *
Your answer
How comfortable are you with talking to young people, one on one? (all answers are okay!) *
*
Your answer
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