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Mentee Application Form
We are seeking mentees who are:
Members of the 2SLGBTQIPA+ community.
Under t
he age of 18.
Able to make a weekly or bi-weekly commitment to meet with a mentor.
For more information on Mentorship, check outÂ
https://www.northernmosaic.net/nmn-mentorship-program
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Email
*
Your email
Name
*
First and last name
Your answer
Email
*
Your answer
Phone number
*
Your answer
Pronouns
*
Your answer
Gender
*
Your answer
Community
*
Your answer
Sexual Orientation
*
Your answer
Cultural Background
Your answer
Name of school and grade
Your answer
What do you like about school?
Your answer
What do you find most challenging about school?
Your answer
What kind of activities would you like to do with your mentor?
*
Your answer
What are your hobbies and interests? What do you like to do for fun?
*
Your answer
Do you participate in any extracurricular activities?
Your answer
What are some of your future goals? Things you dream about after high school?
Your answer
What are some skills you are interested in learning more about with the help of a mentor?
Education goals (eg. studying tips)
Employment goals (eg. create a resume, prepare for a job interview)
Communication goals (eg. how to navigate challenging conversations)
Social goals (eg. increase positive social interactions, overcome social anxiety)
Community engagement/involvement (eg. volunteering)
Cultural (eg. how to make a cultural dish)
Health (eg. going to a fitness class, going swimming)
Life skills (eg. how to budget finances, how to set goals)
Other:
When would you be available to meet with your mentor?
Morning - 9:00-12:00
Afternoon - 12:00-5:00
Evening - 5:00-8:00
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Morning - 9:00-12:00
Afternoon - 12:00-5:00
Evening - 5:00-8:00
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
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