Skip survey header

CLICKS Mentor Online Application

Personal Information

Program Affiliation *This question is required.
Contact Information
Correspondence will be sent to this email address, so please check it regularly. This question requires a valid email address.
Demographic Information
This question requires a valid date format of MM/DD/YYYY.
Racial Identification *This question is required.
Gender *This question is required.
What are your preferred pronouns? *This question is required.
Do you identify as LGBTQ?
Marital Status
Do you have children?
Are you bilingual?
Preferred Language
Is anyone in your family currently an active military service member or veteran?
Do you have a disability?