Find a Mentor

Sign-up to find a mentor
*Disclaimer: All 17 and under youth must have parent/ guardian sign-off to join the program*

Name

Legal Name (if different)

Address

Phone

Mobile Phone

Language(s) Spoken

Date of Birth

YYYY

Race/Ethnicity

Sexual Orientation

Gender Identity

Elementary School

Referred By

Employer

Emergency Contact

Emergency Contact Phone

Emergency Contact E-Mail

Occupation

May we contact you at work?

Yes

Other interests that will be helpful for LifeWorks Staff to know about

Sign-up to find a mentor
*Disclaimer: All 17 and under youth must have parent/ guardian sign-off to join the program*

What is Mentoring to you?

What has been your experience with LGBT adults?

Explain what “boundaries” mean to you?

Have you ever been in a mentoring relationship?

What do you think are three of the biggest issues facing Lesbian, Gay, Bisexual and Transgender (LGBT) youth?

What are some of the most important attributes that a mentor should possess?

What do you want to gain from the experience?

Do you have any medical or mental health conditions that LifeWorks staff should be aware of?

What are the best times for you to attend LifeWorks Activities?

This information is intended to provide preliminary information. Additional information will be obtained by Lifeworks Mentoring Program.