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`A`ALI`I Mentor Application 2024-25
Deadline to submit application is Saturday, June 15, 2024
.
In this section, please provide your contact information and basic background.
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* Indicates required question
Email
*
Your email
Legal Last Name
*
Your answer
Legal First Name and Middle Name (or Initial)
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Your answer
Email
*
Your answer
Mobile number with area code
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Your answer
Home Address including zip code
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Your answer
Date of Birth
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MM
/
DD
/
YYYY
Current Occupation
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Your answer
Name of CURRENT EMPLOYER and POSITION. If retired, list most recent employer and position.
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Your answer
High School name and graduation year (or GED completion year)
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Your answer
Please share the following: (1) Name(s) of college(s)/post-secondary institution(s) attended, (2) graduation year(s), (3) Certificate(s)/degree(s) earned, and (4) Area(s) of study or expertise
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Your answer
What is your gender?
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Female
Male
Non-binary
Do you identify as LGBTQA+?
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Yes
No
Prefer not to say
Check which describes your relationship status.
*
Married
Single, never married
Single, separated/divorced
Single, widowed
Single, in a long-term relationship
Other:
Required
How many children do you have, if any, and what are their ages?
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Your answer
Check which describes your background. (Check all that apply)
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First generation immigrant (born outside US or born in US of immigrant parents)
First in family to graduate from higher education (trade school, community or 4-yr college)
Neither of the above
Other:
Required
Which ethnic/cultural groups do you consider yourself to be a member? Please check all that apply.
*
Black or African-American
Chinese
Filipino
Hispanic or Latino/a/x
Japanese
Korean
Micronesian
Native American or Alaska Native
Native Hawaiian
Polynesian
South Asian
Southeast Asian
White
Prefer not to declare
Other:
Required
What language(s) do you speak other than English?
*
Your answer
What social media platforms do you use? (check all that apply)
*
Facebook
Instagram
LinkedIn
SnapChat
TikTok
Twitter
I don't use any social media
Required
Are there other social media platforms not listed above that you use?
Your answer
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