This application form is used for potential mentors through the LGBT Chamber's Emerging Leaders Program. You may also return a hard copy via email if you prefer. Contact jason@wislgbtchamber.com for more information.

All answers will help not only select mentees, but also help to pair with mentors.

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* 1. Mentee Applicant Name and Contact Information

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* 2. College/University You Are Attending

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* 3. What level of college will you be in during 2016-2017 academic year?

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* 4. Intended Major(s) and/or Minor

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* 5. Please list prior work or intern experience

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* 6. Which industry or industries would you prefer your mentor to belong to? (You may select more than one. No guarantees you will be matched by this.)

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* 7. How do you prefer to identify:

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* 8. What interests you most in participating as a mentee?

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* 9. What do you hope to get out of the Emerging Leaders Program?

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* 10. Please share a brief biography of yourself:

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* 11. In what ways/mediums would you prefer or be open to engaging with a mentor? This will allow us to find an appropriate match. Please check all that apply

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* 12. Do you have any other comments, questions or concerns?

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