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* 1. First Name and Last Name

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* 2. Age and Birthdate (mm/dd/yyyy)

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* 3. Phone Number and Email

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* 4. How do you identify? 

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* 5. What do you feel is the hardest struggle in your life currently at the moment? What upsets you the most currently. What is your stress level 70% of the day?

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* 6. What do you hope to get out of  your mentoring? Example: Help with school, friends, family, family issues, divorce, anxiety, depression, mood, or how you identify yourself (gender identity or sexual orientation).

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* 7. What are you looking for in a mentor? Examples: can relate to you, similar age, create action plans with them, gender specific (please identify which gender you would be most comfortable with)...etc

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* 8. How do you see yourself on a day to day basis? If you were to give yourself one word to describe you what would it be? and why?

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* 9. If you were to change one thing about yourself what would it be? and why? Do you ever feel people look at you differently than you see yourself?

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* 10. What are you more comfortable with: Group sessions with other people that feel the same as you, Or individual meetings, facetime/calls or texting with your mentor? Or are you open to both?

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