P2P Grad Connect: Peer to Peer BIPOC (Black, Indigenous, and People of Color) Mentoring Program

Thank you for your interest in the Laney EDGE and the Office for Racial and Cultural Engagement mentoring program. This is a great opportunity to connect first year Black, Latinx, APIDA, Indigenous, and Multiracial Laney students with peer mentors who are further along in their graduate career.

This form is for BOTH those interested in being a mentee or a mentor. Please email Taína Figueroa (tfiguer@emory.edu) with any questions or concerns.

Name Name First Last
Preferred Name (if different from above)
Are you an international student?

Are you an international student? Yes No
Emory ID
Maximum of 7 digits allowed. Currently Entered: 0 digits.
Phone Phone - ### - ### ####
International Phone
Where do you call home outside of Atlanta (City/State/Province/Country)?
Date of Birth Date of Birth / MM / DD YYYY
Emory Email
Other Email
Department/Program of Study
Maximum of 20 words allowed. Currently Entered: 0 words.
You are in which year of your PhD program?

You are in which year of your PhD program? First Year Second Year Third Year Fourth Year Fifth Year Sixth Year or Beyond
Identity-Based Information
Race (select all that apply)

Race (select all that apply) Asian/Pacific-Islander/Desi, Asian-/Pacific Islander-/Desi-American, Asian/Pacific Islander/Desi Heritage Black, African, African-American, African-Heritage Latina/o/x, Latin American, Hispanic Heritage Middle Eastern, Middle Eastern-American, Middle Eastern Heritage Indigenous, First Nations, Native American, American Indian White, European, European-American, European Heritage Multiracial, Biracial, Mixed Prefer not to answer Another racial identity not listed (please specify)
Gender (select all that apply)

Gender (select all that apply) Woman Man Non-binary Cisgender Trans Pefer not to answer Another gender identity not listed (please specify)
Pronouns (select all that apply)

Pronouns (select all that apply) she/her/hers he/him/his they/them/theirs Another option not listed (please specify)
Emergency Contact Information
Emergency Contact Emergency Contact First Last
Relationship to Applicant
Phone Phone - ### - ### ####
International Phone
Matching Information
Are you interested in being a mentor or a mentee?

Are you interested in being a mentor or a mentee? Mentor Mentee
To help us match you with an appropriate mentor what is most important to you in a P2P Grad Connect Mentor?

To help us match you with an appropriate mentor what is most important to you in a P2P Grad Connect Mentor? Racial or Ethnic Identity Gender Area of Study Other Other
Have you ever participated in a mentorship program before (either as a mentee or a mentor)?

Have you ever participated in a mentorship program before (either as a mentee or a mentor)? Yes No
Please describe what kind of mentorship program (s) you participated in and if you did so as a mentor or mentee (or both!).
Describe why you are interested in participating in the RACE/EDGE Mentoring Program.
Maximum of 250 words allowed. Currently Entered: 0 words.
What are your expectations of a mentoring program?
How would people close to you describe your personality?
Maximum of 100 words allowed. Currently Entered: 0 words.
Do you have any additional questions or comments?

P2P Grad Connect: Peer to Peer BIPOC (Black, Indigenous, and People of Color) Mentoring Program

P2P Grad Connect: Peer to Peer BIPOC (Black, Indigenous, and People of Color) Mentoring Program

Identity-Based Information

Emergency Contact Information

Matching Information