GPS Mentee Application

Applicants will be notified about matches by Thanksgiving Break 2016.

Today's Date Today's Date / MM / DD YYYY
Name
Pronouns (he/him/his, they/them/their, no pronouns, etc.)
Northwestern Student Email
Current Address Current Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone Phone - ### - ### ####
Date of Birth Date of Birth / MM / DD YYYY
Race/Ethnicity
Gender Identity (female, gender queer, etc.)
Sexual/Affectional Orientation (based on your attraction)
Relationship Status (single, dating, etc.)
Religious/ Spiritual Ideology (if any)
Student Year (Freshman, third year, etc.)
Academic Major
If you are an international student, please list your country of origin.
How did you hear about the Guidance and Peer Solutions (GPS) Program?
Why are you interested in being part of the GPS program? What has been your experience (if any) with the LGBTIA community so far, and what do you hope to get out of your involvement with GPS? What are you looking for in a mentorship relationship?
In order to best pair you with a Mentor that suits your needs, please list some of your personal interests, hobbies, activities, and goals. Also, do you have preferences as to the sexual orientation, gender identity, race/ethnicity, religious identity, political views, majors, family circumstances, interests, etc. of your mentor?
Have you participated in LGBTQIA training? If not, would you be willing to participate in Real Talk offered by Multicultural Student Affairs? Select all that apply.

Have you participated in LGBTQIA training? If not, would you be willing to participate in Real Talk offered by Multicultural Student Affairs? Select all that apply. Yes, I have No, I haven't I would be willing to particapte in Real Talk