Hispanic Black Gay Coalition LGBTQ Mentorship Program- Mentor Application
Hispanic Black Gay Coalition (HBGC) appreciates your interest in our mentorship program.  The mentorship program is designed to help youth of color develop a positive LGBTQ identity while deepening the necessary skills to thrive as individuals. LGBTQ mentors will aim to support students in a safe, caring, one-on-one relationship while they work on their personal, social, academic, career, and life goals.

The outcomes of this program greatly depend on your commitment to it. Please be sure you are able to meet its minimum requirement, including meeting with your mentee at least once per month for at least six months before you consider applying.

If you have any questions about this application or program, please email mentorship@hbgc-boston.org. The application deadline is January 22, 2016.  Upon submitting your application, you will be contacted for a brief phone screening.

In addition, please note the following required training dates:
Training #1: February 18, 2016
Training #2: February 23, 2016
Make- up training: Feb 25, 2016
Match Orientation: March 1, 2016
 

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Name *
Address *
Email *
Phone Number *
Ethnicity *
Gender *
Gender Pronouns (ex: she/her/hers)
Sexual Orientation *
Birthdate *
How did you hear about HBGC’s mentorship program? *
Have you ever served as a mentor before? *
Do you speak Spanish? *
Required
Why would you like to participate in this mentorship program? *
What personal or professional experiences, skills, values, and or knowledge do you desire to pass on to your mentee? *
What are your interests and hobbies, please be specific (i.e. playing tennis, playing guitar etc..)? *
How much time are you available to spend with your mentee each month? Do you have any time/date restrictions in 2016? *
Is there a particular youth you would like to work with? (i.e. Ethnic background, academic interest, language etc…) *
What kinds of support/assistance are you looking to give to your mentee? What do you believe your strengths are as a mentor? (check all that apply) *
Required
What type of support will you need to succeed in this program/What personal goals (if any) do you have for serving as a mentor? *
Please provide a reference that we may contact to speak about you. (Name, relationship, phone, email) *
Please provide a second reference that we may contact to speak about you. (Name, relationship, phone, email) *
Please provide a third reference that we may contact to speak about you. (Name, relationship, phone, email) *
I declare that all the information contained within this form is true and accurate. My signature below represents an acceptance of my commitment to participate in HBGC's LGBTQ Mentorship program upon completion of the program's training. I also acknowledge upon acceptance that I will be required to complete a CORI background check.   *
Type your name ONLY if you accept commitment to participate in HBGCs LGBTQ Mentorship program upon completion of the program's training.
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