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Palmer Scholars Mentor Application

We are seeking leaders like you to mentor a Palmer Scholar. We want mentors who are culturally competent and who are interested in providing advocacy, resources, and support while serving as a role model for our young leaders of color in Pierce County. The scholars are matched with a mentor during their senior year of high school. Mentors commit to cultivating and sustaining the mentor/mentee relationship -while the scholar is attaining a post-secondary degree. This includes meeting or speaking with their mentee at least twice a month.

We match mentors and mentees based on answers given to the following questionnaire and on interactions we have with both parties. The questions and interactions help us pair the mentor and mentee's commonalities and shared interests including career interests, passions, personality, personal identity, and academic interests. It is possible that within a given class of seniors we may not find the appropriate match. In that case, not all mentors will be placed with a mentee the current year. There may be occasions when a mentor is matched with a student already in college.
Contact Information
1.First Name(Required.)
2.Last Name(Required.)
3.Date of Birth 

MM/DD/YYYY(Required.)
4.Preferred Phone Number(Required.)
5.Phone Type of Preferred Number(Required.)
6.Texting 

Are you comfortable receiving mentoring-related communications from Palmer Scholars staff (quick reminders & requests) via text message? If so, we will not abuse this right!(Required.)
7.Preferred Email  Address

We will use the email address you provide here for all Palmer Scholars-related communications going forward.(Required.)
8.Preferred Method of Initial Contact 

If you have not already had contact with mentor program staff, how would you like to be contacted to set up a one-on-one appointment to meet with the Director of Scholar Support?(Required.)
9.Mailing Address(Required.)
Personal Identity
We hope to make this process equitable and inclusive for both the mentors and mentees. We acknowledge that both our mentors and mentees come from diverse backgrounds and we want to respect and acknowledge these identities in the matching process. Our mission is to provide our young Scholars of color the agency to be paired with the mentor with whom they would feel most comfortable.
10.What is your Gender Identity? 

Please select all that apply.(i.e. Female, Male, Transgender, Trans-Man, Trans-Woman)(Required.)
11.What are your pronouns? 

Pronouns are the words you use to describe yourself other than your name such as she/her, him/he, ze/hir, they, etc.(Required.)
12.What is your Race/Ethnicity?

Please select all that apply.(Required.)
13.Do you identify as a part of the LGBTQ community? 

Please only select yes if you would like to share this information with the Palmer Scholars staff and have it be used to pair you with a Scholar who also identifies as LGBTQ. Our hope is to provide safe spaces for our LGBTQ+ Scholars, one way to do so it to allow them the agency to request a mentor that is possibly in the same community as them.(Required.)
Matching Preferences
14.If possible, would you prefer to be matched with a mentee of the same:

Please select all the apply (you can choose more than one). Our hope is to provide safe spaces for our young Scholars of color to grow and challenge themselves. One way to do so is to allow them the agency to request a mentor that is possibly in the same community as them. We hope to make this process equitable and inclusive for both the mentors and mentees. We acknowledge that both our mentors and mentees come from diverse backgrounds, and we want to respect and acknowledge these identities in the matching process. Although we challenge our Scholars to grow out of their comfort zone and to challenge themselves academically and socially, we recognize the need to foster relationships that build and strengthen their personal identities. Our goal is to provide you, as mentors, and our young Scholars of color, the agency to be paired with each other based on common interests such as your personal identities, in order to promote a relationship that will strengthen and grow throughout the Scholars' journey of attaining a post-secondary education.(Required.)
15.Check the boxes corresponding to the students with whom you are open to being matched.(Required.)
**Note About Matching**

There may be other very personal identifiers that you would like to have considered as we match you, or your preference may be to be matched with a student who represents a specific community that you feel a special connection to (one that does not reflect your own personal identity). You will have the opportunity to make these additional requests at your one-on-one meeting with the Mentor Program Director!

Example of such a request: a non-LGBTQ+ identifying individual who is an active advocate for the LGBTQ+ community and who wishes to be matched with a student who identifies as such
Education
16.Please select the highest level of education attained(Required.)
17.Please name the institutions from which obtained any diploma/degree that you hold and your major or area of specialization.

You need only fill in the lines that apply to you.(Required.)
18.Additional Comments / Notes Regarding Your Education
Professional Life & Interests
19.Current Organization/Employer  (Required.)
20.Current Title/Position  (Required.)
21.Community Involvement

Please list any community activities or groups you are involved in outside of work that you are open to sharing with us: e.g. YMCA volunteer, member of ____ church or temple, The Black Collective, Neighborhood Council, etc.

Please do not use acronyms, and put N/A if it doesn't apply.(Required.)
22.Other Career Experience

Please list other career fields in which you have been employed and/or other areas of professional/academic expertise.(Required.)
23.(OPTIONAL) Upload your resume
No file chosen
24.Recreational Activities/Interests 

Please check all the boxes that represent activities that you enjoy, and that you would enjoy sharing with your mentee.(Required.)
Other Questions
25.Three Characteristics

If you had to choose three characteristics to describe you, what would they be?  i.e. funny, determined, emotional, loyal, studious, serious, etc.(Required.)
26.What do you hope to gain from the mentoring relationship? 

Please be specific, but keep in mind that you will also have the opportunity to provide more detail when you meet with the Director of Scholar Support(Required.)
27.Why do you want to be a Palmer Scholar Mentor? 

Please be specific, but keep in mind that you will also have the opportunity to provide more detail when you meet with the Mentor Program Director.(Required.)
28.How did you learn about this volunteer opportunity? 

Please let us know how you learned about our mentoring program.  If you learned of us through a specific individual, please provide that person's name.(Required.)
29.Accessibility Needs 

Are there any special accommodations that you would find helpful at events or trainings?
30.Feedback on Mentor Application 

We hope to make this process equitable and inclusive for both the mentors and mentees. We acknowledge that both our mentors and mentees come from diverse backgrounds, and we want to respect and acknowledge these identities. Do you have any feedback on ways to make this survey more inclusive and/or enhanced?