Shippensburg University - Mentee Submission Form

What is your gender identity? (If you have multiple gender identities, feel free to put them all or what you feel comfortable sharing. If you do not have a gender, feel free to write N/A.)

What is your sexual orientation? (Sexual orientation refers to how you identify your attractions to other people. If you are asexual, feel free to write asexual or to write N/A if desired.)

What is your romantic orientation? (Some people, including asexual folks, may be romantically attracted to people while they are not necessarily sexually attracted to people. Others may, for example, identify as heterosexual but feel that they are romantically attracted to all genders and identify as biromantic. If this question does not apply to you, feel free to write N/A. If you are aromantic, feel free to write aromantic or N/A if desired.)

What is your race/ethnicity? (If you are an Indigenous person, you may write Indigenous, the name of your nation(s), or N/A if desired).

What year are you in school? (If you are a transfer student, please select transfer student and the year.) First Year Second Year Third Year Fourth Year+ Transfer Student Graduate Student High School Student/Concurrent Enrollment

Do you have any accommodation needs for this program to work for you? (For example, do you need access to sign language interpreters, braille forms, translators for languages other than English, and/or a mentor that speaks/signs a language other than English or ASL?) Please explain.

What are you seeking in a mentor? This can include whether you are seeking other students, advanced undergrads/graduate students, alumni, and/or faculty/staff, a mentor of a shared race/gender/sexual orientation/ability, someone in your same major, someone with particular skillsets you are looking to develop, etc.

In submitting this form, I consent to the Pride Center staff having access to my answers in order to match me with a well fitting mentor. I consent to the Pride Center using my demographic data (e.g. gender, race, ethnicity, sexual orientation) to assess who is using the center, with the understanding that this data will be disconnected from my name, email, student ID and anything else that could identify who I am to others. I consent to the Pride Center emailing me in order to arrange a time to meet with the Pride Center director and my potential mentor. I agree. I do not agree. I would like to be contacted by the Pride Center to discuss this further.

I understand that this program is meant to be utilized as a way for students to further their identity, academic, and professional development and to foster holistic growth. I understand that this program is not meant to be used for romantic/sexual purposes. I understand that my mentor and I will agree upon set boundaries around when and where we meet and what we discuss and that violating those boundaries will be considered an abuse of the mentoring program. I understand that mentor/mentee program participation can end if the Pride Center staff feel that the program is being abused or are alerted to anything unsafe occurring. I agree. I do not agree. I would like to be contacted by the Pride Center to discuss this further.