BECOME A MENTEE

You are not alone. Blind Queens matches young women who are blind or visually impaired with mentors who listen, encourage, and walk alongside you. Complete the application below and we will help you find your match.

MENTEE APPLICATION

Fields marked required must be completed. All other fields are optional.

Basic Information

Full name (required)

Email address (required)

Phone number (optional)

Age (required)

If you are under 18, please add a parent or guardian below.

Parent or guardian name (optional)

Parent or guardian email or phone (optional)

About You

Are you blind or visually impaired? (required)

Blind

Low vision or visually impaired

Prefer to describe

Tell us a little about yourself (required)

Are you currently in school or working? (optional)

Support & Mentoring Goals

What kind of support are you looking for? (required — choose all that apply)

Confidence and self-esteem

School and academics

Career and job readiness

Independent living skills

Assistive technology

Friendship and community

Other

Why would you like a Blind Queens mentor? (required)

What goals would you like to work on with your mentor? (required)

Mentor Preferences

Would you prefer a mentor who is also blind or visually impaired? (optional)

Preferred way to connect with your mentor (optional)

How often would you like to meet with your mentor? (required)

Any accessibility needs or accommodations we should know about? (optional)

Location & Travel

City and state (required)

Are you able to travel to Blind Queens events? (optional)

Yes

Virtual participation only

It depends

Additional Information

Anything else you would like us to know? (optional)

I commit to showing up for my mentor meetings, communicating openly, and treating my mentor with respect. (required)

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