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AvenueE Mentor Application
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AvenueE Mentor Application
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Contact Info
Name
First
Last
Email
Phone
Please choose a mentor category below:
- Select -
Industry Mentor
Faculty Mentor
Peer Mentor
Position Title
Employer/Institution
Address
Address
City/Town
State/Province
- Select -
Alabama
Alaska
American Samoa
Arizona
Arkansas
Armed Forces (Canada, Europe, Africa, or Middle East)
Armed Forces Americas
Armed Forces Pacific
California
Colorado
Connecticut
Delaware
District of Columbia
Federated States of Micronesia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
ZIP/Postal Code
Optional Questions
Gender
- None -
Woman
Man
Trans Woman / Trans Female
Trans Man / Tans Male
Genderqueer / Gender non-conforming
Non-Binary
Two-Spirited
Different Identity
Prefer Not To Disclose
Different Gender Identity
How do you self-identify?
- None -
Hispanic, Latino, or Spanish Origin
American Indian or Alaskan Nation
Asian or Asian American
Black or African American
Native Hawaiian or Other Pacific Islander
Middle Eastern / North African (MENA)
White
Prefer Not To Disclose
Multiethnic or multiracial
Please select the Asian racial/ethnic subgroup you identify with.
- None -
Bangladeshi
Bhutanese
Burmese
Cambodian
Djiboutian
Filipino
Hmong
Indian
Indonesian
Japanese
Korean
Laotian
Malaysian
Mongolian
Nepali
Pakistani
Singaporean
Sri Lankan
Taiwanese
Thai
Vietnamese
Prefer Not To Disclose
Different subgroup
Please select the MENA racial/ethnic subgroup you identify with.
- None -
Afghan
Assyrian
Algerian
Bahraini
Chaldean
Egyptian
Emirati
Iranian
Iraqi
Israeli
Jordanian
Kurdish
Kuwaiti
Lebanese
Libyan
Mauritanian
Moroccan
Omani
Palestinian
Qatari
Saudi Arabian
Somali
Sudanese
Syrian
Tunisian
Turkish
Yemeni
Prefer Not To Disclose
Different subgroup
Please select the racial/ethnic subgroups you identify with.
- None -
Hispanic, Latino, or Spanish Origin
American Indian or Alaskan Nation
Asian or Asian American
Black or African American
Native Hawaiian or Other Pacific Islander
Middle Eastern / North African (MENA)
White
Prefer not to disclose
Please Specify: Ethnicity or race not listed above.
Additional Info
Are you a 1st Generation College Student?
Yes
No
Are you able to drive to UC Davis or one of our Community College Districts to meet your mentee in person?
Yes
No
Do you have preferred mentee location?:
- Select -
American River College
Berkeley City College
College of Alameda
Contra Costa College
Cosumnes River College
Diablo Valley College
Folsom Lake College
Laney College
Sacramento City College
Los Medanos College
Merrit College
San Joaquin Delta College
University of California, Davis
No Preference
Why do you want to be an AvenueE Mentor?
Please briefly describe your interests, education, work experiences, professional communities, etc. to best match you with a student.
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