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Name of Mentor:

I am comfortable with the gender of My Mentor

I am comfortable with the age range of My Mentor

I am comfortable with the communication style of My Mentor

I would feel more comfortable talking with a Mentor who is:  (Please check all that apply:)

I would feel more comfortable talking with a Mentor who is more knowledgeable in the following  (Please check all that apply:)

My Mentor is available when I am available:

These are the best times to reach me: (Please check all that apply)
      Sunday Monday Tuesday Wednesday Thursday Friday Saturday
   
   
   

My mentor contacted me using the method (phone or email) that I requested:

This is the best way to reach me:

Please check the most appropriate statement below: