Peer Mentee Form
Please fill out this form if you are interested in being a mentee!
Name (first, last):
Your answer
Email:
Your answer
Cell Number:
Your answer
CU Net ID
Your answer
Age:
Your answer
Campus or local address:
Your answer
Ethnicity (check all that apply):
Sexual Orientation:
Gender Identity:
Academic Level:
What is your field of study?
Your answer
I was referred to the LGBT Peer Mentoring Program by:
What is your involvement, if any, with the LGBT community? (select all that apply):
How "out," or open about your identity would you characterize yourself as?
How do you currently feel about your sexuality? Please select a classification for each item: confused, depressed, worried, uncomfortable.
Not at all
Somewhat
Very much so
Confused
Depressed
Worried
Uncomfortable
How do you currently feel about your gender identity? Please select a classification for each item: confused, depressed, worried, uncomfortable.
Not at all
Somewhat
Very much so
Confused
Depressed
Worried
Uncomfortable
Why do you seek a mentor?
Your answer
This concludes the application. If you have any questions, please contact the LGBT Resource Center at LGBTRC@Cornell.edu
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