LGBTQ Mentorship Program: Application for Alumni, Faculty, Administrators, and Staff to be Mentors
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First Name *
Last Name *
Preferred Name
Email *
Address *
Phone Number *
Use Discretion when calling *
Previous Area of Study *
Current Job Position/Title: *
Graduation Year *
Date of Birth *
Age *
Sex *
Required
Gender *
Required
Sexual/Affectional Orientation *
Required
Racial/Ethnic Background(s) with which you identify *
Required
International Status *
Country of Origin *
Relationship Status *
Required
Religious/Spiritual Ideology (if any)
What brings you to the Mentoring Program? *
What are some of your interests in being a mentor to currently enrolled LGBTQ students? *
What are some of your educational/professional goals/interests? *
Where have you worked? What are you doing now? *
How do you see your experiences benefiting our current students? *
How did you hear about the Mentoring Program? *
What involvement, if any, do you have with the LGBTQ community at Dickinson? Outside of Dickinson? *
DISCLAIMER: The Program attempts to match mentees with mentors based on similarities in characteristics, such as sexual orientation, gender, interests, and race/ethnicity. In the event that a mentee with the same characteristics as yours is not available, the program will match you with the person who is most similar to you. If you have any comments, wish to add any additional information, or have any preferences for a type of mentee, please note them here. You are strongly encouraged to list those traits which are important to you for your mentee to share (i.e. ethnicity, religion, etc.).
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