Mentor Application
Thank you for your interest in becoming a QUEST mentor and your interest in the Kent State
LGBTQ+ community. Please take a moment to fill out this brief application and send to Ken
Ditlevson at kditlevs@kent.edu.
Name:________________________ Pronoun: He/Him She/Her They/Them Other(specify):________
Email:___________________________________
Phone: _________________________________
Address: _____________________________________________________________________________
Job Position/Title: _____________________________________________________________________
Company Name/Location: _______________________________________________________________
If applicable, Religious/Spiritual Affiliation: _________________________________________________
I Identify As:
Gay
Lesbian
Queer/Genderqueer
Bisexual
Transgender
Other_________________
Are you able to commit to a monthly contact?
Yes
No
Are you a college graduate?
Yes
No
What is your preferred mode of contact with a mentee?
Phone
Email
Are you able to commit to a monthly contact?
Yes
No
What interested you about this program?
What are you hoping to gain from being a mentor?
What do you hope to offer as a mentor?
What are you interests/hobbies?
Any other important information about yourself that you would like to share?
In-person