Gender Identity (we ask about trans identity so that we can take that into account if pairing you with someone or in helping you through this programming) *
Email *
Your answer
Phone Number
Your answer
Preferred Method of Communication *
Instagram handle *
Your answer
Would you like to be added to our instagram community to learn more about our programming and to stay up to date with POC programming and other announcements? *
What city and state do you reside in? *
Your answer
What is your racial-ethnic background? *
Your answer
Are you seeking to be a mentor, mentee, a part of the leadership team, a mental health workshop facilitator, or an artist? *
Any preferences for your mentor or mentee? Please put N/A if you are signing up as an artist or mental health workshop facilitator. *
Your answer
What are you hoping to gain from the Mentoring POC experience? *
Your answer
What topic(s) would you like us to focus on that would best support you at this time? *
Your answer
How did you hear about us? *
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Psyches of Color. Report Abuse