TransMentor Volunteer Intake
Those wanting to volunteer as a mentor for the TransMentor program must provide the following information. ::DISCLAIMER:: **The volunteer mentors are peer mentors and are NOT licensed medical or mental health professionals. Their thoughts and opinions are their own and do not necessarily represent those of Trans Empowerment Project. Any opinions/advice/suggestions/thoughts/etc. of any Mentor do NOT have to be taken or followed at all. If you feel that your mentor is acting inappropriately or have any issues whatsoever, you are free to contact James.Blake@transempowermentproject.com.**
Email address *
Name *
Your answer
Birthday *
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DD
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YYYY
Address- Please include at minimum your city & state *
Your answer
Phone
Your answer
Preferred Contact Method *
Gender- Feel free to check more than one box *
Required
What is your relationship to the Transgender or LGBQ population? - Feel free to check more than one box
How did you hear about our TransMentor Program?
Your answer
Why would you like to become a TransMentor?
Your answer
Have you ever been a mentor or mentee in a mentor program before?
How many genders are there? *
Your answer
What is your idea of a "safe person"? *
Your answer
What is your definition of a "safe space"? *
Your answer
What is your definition of "intersectionality"? *
Your answer
What is your definition of a positive mentorship? *
Your answer
Do you have any religious preferences you would like us to keep in mind when matching you to a trans mentee?
Your answer
Please Provide 3 references with contact info *
Your answer
Do you have any allergies, such as to animals, that we should know about when matching you with a mentee?
Your answer
Have you been convicted of a crime? *
If yes to a criminal conviction, please explain:
Your answer
Do you have any mental health diagnoses? If yes, explain:
Your answer
Have you had any emergent mental health concerns in the past 6 months? *
Are you currently under the care of a mental health professional? *
When working with the transgender population, many of these clients will be facing issues such as: Family Rejection, Abuse, Harassment, Homelessness, Discrimination, Survival Crimes, Harmful Coping Skills, Isolation, Depression, to name a few. Are you comfortable working with individuals dealing with these circumstances? Please explain your answer: *
Your answer
Do you consent to a background check? *
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