Panthers Out Front- LGBTQIAP+ Mentor Form

Panthers Out Front- LGBTQIAP+ Mentor Form

Mission: The Center for Gender & Sexual Diversity's Mentoring Program, Panthers Out Front, wants to promote the success of EIU students by introducing diverse sexual orientations and gender identities. This program helps students expand their potential as individuals and connect with other LGBTQA+ students, faculty, and staff at EIU in a friendly and confidential setting. Out Front will provide students with opportunities to become involved in creating a safe, inclusive, and welcoming environment for LGBTQA+ students on campus. Student mentors will gain valuable experience and skills that will help them as they continue their educational and work experience.

Thank you for showing interest in the LGBTQA+ mentoring program offered by the Center for Gender & Sexual Diversity at Eastern Illinois University. Please fill out the form below to the best of your ability to apply to be a mentor. If you experience discomfort with a question, feel free to leave it blank or select the "Prefer not to answer" option.

Questions? Email the GSD Center at lgbtqa@eiu.edu

Name Name * First Last
My pronouns are... *

My pronouns are... She/Her/Hers He/Him/His They/Them/Theirs Other Other
Email *
What is your position?
(Check all that apply) *

What is your position?
(Check all that apply) EIU Faculty EIU Staff Graduate Student Resident Assistant Undergraduate Student Community Member Other Other
Department you are a part of...
What community organization do you represent?
If you chose RA, please select which applies best...

If you chose RA, please select which applies best... 1st Year 2nd Year 3rd Year 4th Year
Year in school?
I identify my gender as...
(check all that apply) *

I identify my gender as...
(check all that apply) Woman Man Transgender Cisgender Nonbinary Genderfluid Agender Prefer not to answer Another gender identitiy not listed above
I identify my sexuality as...
(check all that apply) *

I identify my sexuality as...
(check all that apply) Lesbian Gay Straight/Heterosexual Bisexual Pansexual Asexual Queer Questioning Prefer not to answer Another sexuality identity not listed above
The following questions will assist with pairing you with a mentee.

Note: We will try our best to match with preferences and interests, but cannot guarantee a perfect match.
How many mentees are you willing to assist? *
How often are you willing to meet with your mentee(s)? *

How often are you willing to meet with your mentee(s)? Weekly Bi-Weekly Monthly Bi-Monthly
Are you a member of the LGBTQ+ community? *

Are you a member of the LGBTQ+ community? Yes, I identify as part of the LGBTQ+ community No, I identify as an ally to the LGBTQ+ community
Are you Safe-Zone trained? *

Are you Safe-Zone trained? Yes No
Why do you want to be a mentor? *
Please describe relevant past experiences that have prepared you to be a mentor (e.g., volunteer experience, other mentoring programs, etc.) *
What are some of your favorite TV shows, movies, books, music genres or artists?
Which of the following would you feel most comfortable helping a mentee with?
(check all that apply)

Which of the following would you feel most comfortable helping a mentee with?
(check all that apply) Coming out to friends, family, peers, etc. Discussing religion, faith, or spirituality Relating to the mentee through a similar racial or ethnic background Finding ways to be proactive with activism Getting more involved on- and off-campus Understanding their identity at a deeper level Helping with concerns of attending a four-year institution Other
If you chose "Discussing religion, faith, or spirituality," please specify your views or denomination...
If you chose "Relating to the mentee through a similar racial or ethnic background," please specify your own racial or ethnic background...
If you chose Other in the question above, please provide more information on what you would be willing to help a mentee with...
Please indicate any topics you would not feel comfortable discussing with your mentee (this information will be confidential).

Please note this will remain confidential between you and the GSD Center staff