Mentor application Mentor application LGBTQ Mentorship mentor application Step 1 of 3 33% Name* First Last Preferred Email* Phone Number* Campus role* Faculty Exempt Staff Non Exempt Staff Graduate Student Campus department* Number of years at UTK* If you are originally from outside the U.S., please let us know your country of origin. Sexual Orientation* Lesbian Gay Bisexual Queer Straight Transgender is a term typically defined as having a gender identity different from one’s gender assigned at birth. Does this term best describe you?* Yes No I prefer not to answer Gender Identity (check all that apply)* Man Woman Gender Queer Non-binary Other Please describe other Gender Pronouns (check all that apply)* He/him/his She/her/hers They/them/theirs Ze/hir/hirs Ey/em/eirs Xe/xem/xyrs Other Please describe other Race/Ethnicity* American Indian or Alaska Native Asian Black or African American Hispanic or Latino/a Multiple Native Hawaiin or Pacific Islander White/Caucasian Prefer not to answer Why do you wish to serve as a Mentor for the LGBTQ+ Mentoring Program?*Have you mentored others in the past? If yes, in what capacity?*What qualities do you possess to serve as an effective mentor?*What types of topics or issues are you willing to mentor your mentee about? (e.g. major selection, navigating professional relationships, navigating personal relationships, seeking LGBTQ+ affirming services)? (Used for matching and pairing of mentors/mentees) What are some professional and personal interests/hobbies? (Used for matching and pairing of mentors/mentees) So we know you are human, please type in answer to 2+3=*By typing in your name you acknowledge your intent to submit this application. First Last