Akanni Mentoring Sign-up

Name*
First Last
Preferred Name (If different)
Your Photo
Address*
Street Address Address Line 2 City State ZIP Code
Email*
Link to your Facebook Page
Phone
Date of Birth*
Date Format: MM slash DD slash YYYY
Race/Heritage*
Stage of Transition*
Marital Status*
Enrollment Details
Mentor/Mentee Enrollment*
As a mentor, What 3 areas would you like to focus on during this program?
Please select up to (3) focus areas
As a mentee, What 3 areas would you like to focus on during this program?
Please select up to (3) focus areas
How much time are you able to commit to mentoring per month?*
Do you have prior experience as a Mentor?*
Please 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?*
Have you taken part in prior mentorship programs?*

Enrollment Details