Lesbian Gay Bisexual Transgender Center at the University of Pennsylvania


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The Lesbian Gay Bisexual Center Mentoring Program matches lesbian, gay, bisexual, transgender, and questioning Penn students with a mentor who can provide them with help concerning their sexual orientation/identity. Confidentiality is assured, and students can move at their own pace. The Mentoring Program is administered by the Lesbian Gay Bisexual Transgender Center at the University of Pennsylvania. All students at the University of Pennsylvania are eligible regardless of age, gender, sexual orientation, gender identity, school, or group affiliation.

NOTE: This is the online form for a student to register to be a mentor. If you want to register to be a mentee, please go to our online Mentee Registration Form.

Last Name:
First Name:
Penn Email:
Date of Birth:	(mm/dd/yy)
Sex:

Sexual Orientaion:	Gay Lesbian Bisexual Questioning
Gender Identity:

Ethnicity: check all that apply	African-American Asian/Pacific Islander Caucasian Latino South Asian International (please specify country) Other (please specify)

Religion:

Permanent Address
Street Address:
City:
State:
Zip Code:
Phone Number:

Campus Address
Street Address:
City:
State:
Zip Code:
Phone Number:

Field(s) of Study:
Year of Graduation:
Extracurricular Activities and Interests:

DISCLAIMER: The Program attempts to match mentees with mentors based on similarities in characteristics, such as sexual orientation, gender, interests, and race/ethnicity. In the event that a mentee with the same characteristics as yours is not available, the program will match you with the person who is most similar to you. If you have any comments, wish to add any additional information, or have any preferences for a type of mentee, please note them here. You are strongly encouraged to list those traits which are important to you for your mentee to share (i.e. ethnicity, religion, etc.).