YES - Apply to Be a Mentor Thank you for your interest in becoming a mentor with YES Mentoring! Please fill out ALL of the following information. All information is kept in a secure database and is used in the matching process. Please note: all fields with an ✱ are required. ✱ First Name ✱ Last Name ✱ Gender: --None--Female Male Other ✱ Birthday: ✱ Race and Ethnicity:--None--White or Caucasian Black or African American Hispanic or Latino/a or Spanish Origin of any race Asian Native American or Alaska Native Hawaiian Native or Other Pacific Islander Two or More Races Other Middle Eastern Race and Ethnicity Unknown Preferred Language: Speak Spanish: We use your home address, company, occupation, and areas you often go to assist in finding a mentee closer to you, and matching to your skill set. ✱ Street ✱ Zip ✱ City ✱ State/Province ✱ Company ✱ Occupation: Frequently Visited Locations: ✱ Maximum Minutes Willing to Travel: --None--15 minutes 15 - 30 minutes 30 - 1 hour No preference ✱ Mobile ✱ Email Please let us know more about you! This help us with matching. Are you: Outgoing: --None--Yes No Sometimes Funny: --None--Yes No Sometimes Kind: --None--Yes No Sometimes Smart: --None--Yes No Sometimes Creative: --None--Yes No Sometimes Shy: --None--Yes No Sometimes How do you Deliver Feedback?: --None--I am nurturing, I comfort as I correct I am direct with my feedback I avoid giving feedback Detail Oriented: --None--Yes No Sometimes Bubbly, Always Smiling: --None--Yes No Sometimes Flexible, Go with the Flow: --None--Yes No Sometimes Blunt, I tell it like it is: --None--Yes No Sometimes Opinionated: --None--Yes No Sometimes Some activities your mentee might need help on are as follows, please let us know how comfortable you are helping with these things: Getting a Drivers License: --None--Yes No I would need extra support Increasing Grade Point Average: --None--Yes No I would need extra support Eating Healthier: --None--Yes No I would need extra support Getting an Internship/Job: --None--Yes No I would need extra support Learn a new Skill: --None--Yes No I would need extra support When thinking about your future mentee, are the following things important to you for the mentee to have/be: Religious Beliefs: --None--Not Important (1) 2 3 4 Very Important (5) LGBTQIA Youth: --None--Not Comfortable (1) 2 3 4 Very Comfortable (5) Pursues Continuing Education: --None--Not Important (1) 2 3 4 Very Important (5) Tell us about things you, as an individual, are interested in and things you are interested in doing with your mentee! In order to select multiple option hold down the command key or window key Interests: Painting Photography Animals Videogames Reading Knitting Cooking Creative writing Playing sports Watching sports Dance Gardening Swimming Singing Bowling Watching movies Exercise Yoga Boardgames Higher education Outer space Computers Shopping Fashion/Beauty Biking Math/Science Fun with Mentee/Mentor: Bake a cake Play a game of any sport Visit the humane society Visit the new library Hike the trails Do a craft Go to a museum Go window shopping Go to a concert/watch live music Go to a movie Go out to try a new restaurant Go to an art festival Is there anything else you wish to let us know? Other Comments: If you are not brought to a thank you page, the form did NOT submit. Please check that ALL required fields are filled out.
