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NeurodiverCity Mentorship Request
Fill out this form to request and be paired with a mentor! Click the link below to view our Mentorship Guidelines and Pairing Process:
https://docs.google.com/document/d/1BXIfwi1l9bxDGP7A0JXqECHt8rhnc3EKs7gjwp26a4A/edit?usp=sharing
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Name (First and Last)
*
Your answer
Preferred pronouns
Your answer
Email
*
Your answer
Age or Grade
Your answer
Which of the following services are you interested in? (You are welcome to select more than one)
Neurodiverse Peer Mentorship from neurodiverse students (free)
Neurodiverse Adult Mentorship (free)
Certified life coaching (free)
Neurodiversity Coaching (subject to coach's fee)
Psychologist Mentoring (may be subject to psychologist's fee, fee is decided mutually)
Tutoring for neurodiverse students (free)
Psychologist Consultations (subject to psychologist's fee)
Why are you interested in a NeurodiverCity mentorship? (please indicate any specific needs or goals you'd like to work on)
Your answer
For mentorships, would you prefer on demand text-only or weekly Zoom check-ins?
On-demand texting (through Discord)
Weekly Zoom meetings
Both
Other:
Clear selection
What is your general location/time zone? (for live Zoom sessions)
Your answer
For live Zoom sessions, would you like to receive automated text/email reminders?
Yes
No
Clear selection
Texting mentorships mainly take place through Discord due to no messaging fees; however, we are also able to accommodate phone text *depending on mentor preference.* Please provide your Discord username with the 4-digit # AND/OR your phone number below.
Your answer
Would you be interested in a "group mentoring" option with all the mentoring/tutoring services available through Discord? (you are welcome to take part in this in addition to 1:1 mentoring)
Yes
No
Other:
Clear selection
Any specific mentor requests? (example: mentor who has experience with ADHD, ASD, OCD, mental health, etc.) OR name of mentor
*
Your answer
Thanks for filling out the form! We will contact you shortly and match you with a mentor based on your preferences above. For any questions, please email
outsidethebox.neurodiversity@gmail.com
.
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