100K Mentors Student Interest Sign-Up

Thank you for taking interest in the 100K Mentor Program! By signing up you will be the first to be notified when the program launches and will give you priority in matching with a professional mentor. The below information will not be shared with anyone and will be used to help us best understand the backgrounds of our mentees. You will be hearing from us soon!

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* 1. First Name

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* 2. Last Name

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* 3. Gender Identity

Female/Woman

Male/Man

Non-binary, genderqueer, or gender-nonconforming

Another gender identity not listed above

Prefer not to answer

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* 4. LGBTQ+

Yes

Prefer not to answer

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* 5. With which racial or ethnic group(s) do you identify?

Native American, American Indian, First Nations, or Alaska Native

Latinx or Hispanic

Black, African American, or African

Asian

Pacific Islander

Middle Eastern, North African, or Southwest Asian

White or European

Another race or ethnicity not listed above

Prefer not to answer

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* 6. Veteran Status

Yes

Prefer not to answer

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* 7. First-Generation College Student

Yes

Prefer not to answer

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* 8. Do you have a disability?

Yes

Prefer not to answer

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* 9. International Student

Yes

Prefer not to answer

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* 10. If Yes, please specify the country of citizenship

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* 11. School Email Address

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* 12. Describe your Education and Interests

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* 13. College or University

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* 14. Major

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* 15. Professional Area of Interest

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* 16. Graduation Year

2021

2022

2023

2024

Other

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* 17. How did you hear about the 100K Mentors Initiative?

Student Group or Organization

LI Outreach

A Friend's Social Media

Friend

Other

100K Mentors Student Interest Sign-Up

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* 1. First Name

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* 2. Last Name

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* 3. Gender Identity

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* 4. LGBTQ+

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* 5. With which racial or ethnic group(s) do you identify?

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* 6. Veteran Status

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* 7. First-Generation College Student

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* 8. Do you have a disability?

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* 9. International Student

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* 10. If Yes, please specify the country of citizenship

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* 11. School Email Address

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* 12. Describe your Education and Interests

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* 13. College or University

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* 14. Major

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* 15. Professional Area of Interest

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* 16. Graduation Year

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* 17. How did you hear about the 100K Mentors Initiative?

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* 18. Refer a Friend #1 (Name | Email) *Optional

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* 19. Refer a Friend #2 (Name | Email) *Optional

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* 20. Refer a Friend #3 (Name | Email) *Optional