Akanni Men's Mentoring Application Name* First Last Preferred Name (If different)Your PhotoAddress* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Link to your Facebook Page PhoneDate of Birth* Date Format: MM slash DD slash YYYY Race/Heritage*I define my race asBlack/African AmericanNative/Indian AmericaLatino/Hispanic AmericanHawaiian/Pacific IslanderAsian AmericanWhite/European AmericanMixed RaceStage of Transition*Length of time transitioningQuestioning<6 Months< 1 Year1-3 Years3-5 Years5-10 Years10> YearsMarital Status*My marital status isSingleMarriedCommitted RelationshipEnrollment DetailsMentor/Mentee Enrollment*I want to become aMentorMenteeAs a mentor, What 3 areas would you like to focus on during this program?Physical WellnessEmotional WellnessSocial WellnessSpiritual WellnessIntellectual WellnessOccupational WellnessFinancial WellnessEnvironmental WellnessPlease select up to (3) focus areasAs a mentee, What 3 areas would you like to focus on during this program?Physical WellnessEmotional WellnessSocial WellnessSpiritual WellnessIntellectual WellnessOccupational WellnessFinancial WellnessEnvironmental WellnessLeadershipPlease select up to (3) focus areasHow much time are you able to commit to mentoring per month?*I have time available20-30 Hours per week10-20 Hours per week5-10 Hours per weekDo you have prior experience as a Mentor?*My level of experience isNoYes, <1 Year ExperienceYes, 1-3 Years ExperienceYes, 3-5 Years ExperienceYes, >5 Years ExperiencePlease share how you have impacted others or been impacted by a similar program/mentorship, to help us know who you are more deeply*What characteristics should a mentor display?*What are the positive attributes of your personality?*What does EMPOWERMENT look like to you?*Who would you say has empowered you the most in your life? Are they trans?*What would you like to give/add/get out of this program?*What does EMPOWERMENT mean to you?*What would you like to gain from the EmpowerHIM Akanni mentor program?Do you consider yourself coachable/teachable?*YesNoHave you taken part in prior mentorship programs?*YesNo