Mentor 24-25 Application

Thank you for your interest and support of BI&POC leadership cultivation and sustainability in our movements. Mentor applications are EXTENDED to December 13, 2024

Full Name

Please include the name you go by, even if it’s not your legal name.

Pronouns

e.g. she/her, they/them, he/him, etc.

Address Line 1

Address Line 2 (optional)

City

State

Zip Code

Mobile Phone

Best way to reach you

Please check all that apply.

How did you hear about us?

Access needs to support your participation

For immunocompromised folx, please share your needs and see question on virtual vs. in person meet ups at the end of the doc.

Current job or type of work you do

Current organizational affiliations (where you currently work or volunteer)

Past organizational affiliation (particularly if you were formerly on staff at another movement organization)

_________________ Demographic Information

Note: We will use demographic information to match people if requested by mentors and mentor partners. We will hold your individual answers in strict confidentiality. While we include some labels that are widely used for convenience, we recognize that these can often leave out many peoples. We encourage you to share the identities that feel more affirming or that are not fully represented in these labels.

27-29

What races / ethnicities do you identify as? (list all)

Please add any racial / ethnic identities that more fully describe you.

What gender identities resonate with you?

If your gender identity matches the gender assigned to you at birth, please select 'Cisgender' in addition to your gender.

Please add any sex / gender labels that more fully describe you.

What is your sexual orientation?

Please add any labels that more fully describe your sexual orientation.

Is the immigrant or refugee experience part of your identity?

What languages do you speak (to hold a conversation in-language)?

What kind of caregiving or parenting is in your daily life?

e.g. elders, kids, nibblings, plants, pets

Age

25-29
30-34
35-39
40-44
45-49
50-54
55-59
60+
spanish

_________________ Please provide brief answers (no more than a paragraph) to each question below:

Who is a mentor that has guided you on your path? What characteristics about this person did you appreciate most?

{name}

What is drawing you to the role of mentorship in this moment?

{name}

What strengths or growth edges will you bring as a mentor? How would others describe you in this type of role?

{name}

What are you loving to spend your time on? Inside and outside of work?

{name}

Anything else we should know about you to match you with your mentor partner?

{name}

_________________ Matching Questions

Note: Please let us know if any of your preferences below are a requirement / must have. We appreciate any flexibility you have to help us in the matching process.

all are preferences, not must haves

Are there any demographic preferences (gender, race, sexual orientation, etc.) or geography (cities or regions of the state)?

Are there any organizational preferences you have (if there are mentor partners from a particular organization you would like to be matched with)?

If applicable, please specify which preferences are requirements / must haves.

_________________ Logistics

Are you able to attend an online orientation session (1.5 hours in January) and closing session (1.5 hours in September)?

Are you available to meet with a mentor partner for 1 hour a month (virtual or in person) for the duration of 8 months from February-September?

Yes
No
In-person mentoring sessions

I understand that not fulfilling these requirements will impact my ability to participate in this program.

Would you like to participate in optional small group pods with other mentors for mentorship consultation and support?

Yes
No
Maybe

Please indicate how you would prefer to meet with your mentor partner (check all that apply):

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