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At PYD, we welcome and include people of all abilities, identities, and backgrounds. We believe that diverse and fully inclusive organizations empower individuals, heal communities, and create a better world for us all.

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First & Last Name (required)

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Street Address

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City

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State (required)

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ZIP Code (required)

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Phone Number (Home)

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Phone Number (Cell)

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Alternate Email Address

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Date of Birth (D/M/Y)

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Primary Language(s) Spoken Clear Selections

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Other Languages Spoken (if not listed above)

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Race & Ethnicity Clear Selections

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Other Race & Ethnicity (if not listed above)

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Level of Education Clear Selections

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Current School

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Years in School

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Current Employment Status Clear Selections

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Other Employment Status (if not listed above)

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Current Employer

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Current Job Title

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Length of Employment with Current Job

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Do you identify as having a disability?

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If yes, what type of disability do you identify as having? Clear Selections

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What specific disability do you identify as having? Clear Selections

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Other Disability (if not listed above)

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Do you need any reasonable accommodations?

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If yes, what reasonable accommodations do you need?

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Have you had any prior experience with a mentor?

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Have you had prior experience with a career mentor?

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Briefly describe yourself. (i.e. Summarize yourself in one tweet!)

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What do you do for fun? Hobbies? Favorite recreational activities? Interests?

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What is your current, past, or anticipated major?

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What are/were your favorite subject areas in school? What type of education did you receive (vocational, public, private, etc.)?

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Describe your employment goals. What is your ideal job? If working, what do you currently do?

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Why do you want to join C3? What do you hope to learn or gain from the program? Are there any specific skills you would like to develop?

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What do you think would be most important in finding you a good match?

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I have read and agree to the Terms of Use & Privacy Policy (required)

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I have read and agree to the Site Rules (required)

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Participating Groups

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