First Name *

Last Name *

Pronouns
She/her/hers
He/him/his
They/them/theirs
Not listed Please specify a value for Pronouns

Email *

Phone *

G-number *

Campus Role (primary) *
- Select Option Faculty Staff Graduate Student

Title and Department (or program of study) *

How long have you been at GVSU? *
- Select Option Less than one year One year or more

How do you describe your sexual orientation?
Queer
Lesbian
Gay
Bisexual
Pansexual
Asexual
Questioning
Not listed Please specify a value for How do you describe your sexual orientation?

Do you identify as...
- Select Option Cisgender (you identify with the gender you were assigned at birth) Transgender (you identify with a gender other than the one you were assigned at birth)

How do you describe your gender identity?
Woman
Man
Genderqueer
Genderfluid
Non-binary
Agender
Not listed Please specify a value for How do you describe your gender identity?

How do you describe your race/ethnicity?
Black/African-American
Latinx/Hispanic
Asian/Asian-American/API/South Asian
Middle Eastern
Native American/Native Alaskan/American Indian
White
Multiracial
Not listed Please specify a value for How do you describe your race/ethnicity?

How do you describe your faith affiliation or worldview?

Is there anything else you would like us to know about your identities to help us match you with potential mentees?

What do you enjoy doing for fun and what are your interests? *

Have you been a mentor with Queer Connections previously? *
- Select Option Yes No

Have you ever served formally (or informally) as a mentor? *
- Select Option Yes No

Please tell us about your previous mentoring experience. *

Why do you want to be a mentor with Queer Connections? *

What qualities do you possess that you think would make you a good mentor? *

Queer Connections is structured around goal-setting with your mentee. Which of the following areas do you feel most equipped to assist with? *
Relationships
Coming Out / Being Out
Career paths
Faith issues and communities
Gender identity and expression
Networking
Race/Ethnicity
Academics
Self-Care
Not listed Please specify a value for Queer Connections is structured around goal-setting with your mentee. Which of the following areas do you feel most equipped to assist with?

Are you out to others about your LGBTQIA+ identities? *
- Select Option Yes No Not listed Please specify a value for Are you out to others about your LGBTQIA+ identities?

Can you commit to monthly in-person meetings with your mentee for at least six months after you are matched? *
- Select Option Yes No

Do you have any ongoing scheduling conflicts that will make in-person meetings with your mentee difficult to arrange? *
- Select Option Yes No