Contact

Phone: 920-424-3465

Email: lgbtqcenter@uwosh.edu

(All information is kept confidential)

Resource Center Hours

Monday through Friday: 9:00 a.m. to 5:00 p.m.

Saturday & Sunday: CLOSED

Please contact us if you cannot make it to the Resource Center during these hours and need assistance.

Location

Room 005 in the Lower level of the Campus Center for Equity & Diversity. Gain access through the Irving Avenue entrance.

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Queer Peer Mentee Application

Your E-Mail Address (Required)

Name (Required)

Phone (Required)

Demographic Information

This information is completely voluntary. You do not need to provide this information if you do not wish to. If you choose to fill out, please use the terminology that is most comfortable for you. One of our goals in creating this mentoring program is to ensure that mentees are able to bring all of their "social identities" to the mentoring relationship. some may wish to have a mentor with similar sexual orientation, racial, ethnic, age, and/or gender background.

Race/Ethnicity/Culture

Gender Identity

Sexual Orientation

Age

Other Demographic Information

Short Answer

These questions will better help us to understand your needs and make the best possible match with a mentor.

1. What issues would you like to work on with a mentor?

2. What are you looking for in a mentor?

3. How would you like your mentor to contact you?

Email
Phone

Alternate means of contact (Required)

If we cannot or should not contact you via your uwosh email or phone, please indicate how we may contact you to provide the best possible support.

All information is kept confidential!

by wolft77 — last modified Jan 26, 2012 04:43 PM

« December 2012 »

Safe, Supportive, and Welcoming

Queer Peer Mentee Application