This application is used to select mentees and to pair selected mentees and mentors for the LGBT Chamber's Emerging Leaders Program. Please complete the online form below, or return a hard copy via email. Contact for more information.

Thank you for your participation.

* 1. Mentee Applicant Name and Contact Information

* 2. College/University You Are Attending

* 3. Level of college during the 2017-2018 academic year

* 4. Major(s) and/or Minor

* 5. Please list prior work, volunteer, or intern experience

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

* 7. How do you prefer to identify?

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

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

* 10. Please share a brief biography of yourself. You can write about your background, year in school, interests, passions, etc. We recommend you write 200 to 300 words.

* 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

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