If you are interested in making an incredible impact on the life of an LBT woman then becoming a mentor to an Aqua Scholar is the perfect fit for you! Mentors are carefully matched each year with a scholar who they will work with. They are expected to maintain monthly communication with their mentee as well as attend quarterly gatherings of the mentors and scholars. A mentor provides encouragement, advice, and support to their mentee.

To apply to become a mentor simply fill out the form below and we will notify you if you have been selected as a mentor once the new scholarship cycle is underway.

Mentor Application

Today's Date *

First *

First

Last *

Last

Date of Birth *

Email *

Home Phone *

Cell Phone *

Address *

Address Line 2

City *

State * AL AK AS AZ CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MH MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

Postal Code *

Employment History

Employer *

Title/Position Held *

Work Address

Address Line 2

City

State AL AK AS AZ CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MH MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

Postal Code

Work Phone

Work Email

Languages Spoken

Previous Volunteer Experience

Have you applied to be a mentor with Aqua Foundation for Women in the past? *

Yes

No

If Yes what year or years where you a mentor??

How would you describe your experience as a mentor?

Questions

Your responses to the following questions will help us determine whether you are a good fit for AFW's Mentor Program and they will help us match you with a mentee.

What qualities, skills, or other attributes do you feel you have that would benefit a mentee? *

What do you think will be most challenging about being a mentor? *

What do you hope to gain from becoming a mentor? *

Do you have any disabilities that may affect your involvement in the program? *

Yes

No

If so, please specify.

What interests do you enjoy? *

Are you out? *

Yes

No

Somewhat

If no or somewhat, please elaborate.

Background Screening

Please attach the completed consent form available for download below.

Downloadable Background Check Form

Signed background consent form *

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Final Comments - Optional

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