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attachment-full size-full" alt="" style="max-width: 100%; height: auto;" decoding="async" srcset="https://www.mentoring.org/wp-content/uploads/2024/06/iStock-Disability-Inclusion-Copy.jpg 1429w, https://www.mentoring.org/wp-content/uploads/2024/06/iStock-Disability-Inclusion-Copy-300x200.jpg 300w, https://www.mentoring.org/wp-content/uploads/2024/06/iStock-Disability-Inclusion-Copy-1024x683.jpg 1024w, https://www.mentoring.org/wp-content/uploads/2024/06/iStock-Disability-Inclusion-Copy-768x512.jpg 768w, https://www.mentoring.org/wp-content/uploads/2024/06/iStock-Disability-Inclusion-Copy-50x33.jpg 50w, https://www.mentoring.org/wp-content/uploads/2024/06/iStock-Disability-Inclusion-Copy-1200x800.jpg 1200w" sizes="(max-width: 1429px) 100vw, 1429px" /></a></li><li class='mega-menu-item mega-menu-item-type-widget widget_custom_html mega-menu-item-custom_html-20' id='mega-menu-item-custom_html-20'><div class="textwidget custom-html-widget"><p></p> <a class="menu-highlight" 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field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible" data-js-reload="field_17_4" ><div class='ginput_container ginput_container_text'><input name='input_4' id='input_17_4' type='hidden' class='gform_hidden' aria-invalid="false" value='' /></div></li><li id="field_17_2" class="gfield gfield--type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible" data-js-reload="field_17_2" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Name<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_17_2'> <span id='input_17_2_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' > <input type='text' name='input_2.3' id='input_17_2_3' value='' tabindex='13' aria-required='true' /> <label for='input_17_2_3' class='gform-field-label gform-field-label--type-sub '>First</label> </span> <span id='input_17_2_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' > <input type='text' name='input_2.6' id='input_17_2_6' value='' tabindex='15' aria-required='true' /> <label for='input_17_2_6' class='gform-field-label gform-field-label--type-sub '>Last</label> </span> </div></li><li id="field_17_15" class="gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible" data-js-reload="field_17_15" ><label class='gfield_label gform-field-label' for='input_17_15'>Title</label><div class='ginput_container ginput_container_text'><input name='input_15' id='input_17_15' type='text' value='' class='large' tabindex='17' aria-invalid="false" /></div></li><li id="field_17_3" class="gfield gfield--type-email gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible" data-js-reload="field_17_3" ><label class='gfield_label gform-field-label' for='input_17_3'>Email<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_email'> <input name='input_3' id='input_17_3' type='email' value='' class='large' tabindex='18' aria-required="true" aria-invalid="false" /> </div></li><li id="field_17_16" class="gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible" data-js-reload="field_17_16" ><label class='gfield_label gform-field-label' for='input_17_16'>Employer/Organization/Property/Brand Affiliation<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_text'><input name='input_16' id='input_17_16' type='text' value='' class='large' tabindex='19' aria-required="true" aria-invalid="false" /></div></li><li id="field_17_17" class="gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible" data-js-reload="field_17_17" ><label class='gfield_label gform-field-label' for='input_17_17'>Role in mentoring program (if applicable)</label><div class='ginput_container ginput_container_text'><input name='input_17' id='input_17_17' type='text' value='' class='large' tabindex='20' aria-invalid="false" /></div></li><li id="field_17_18" class="gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible" data-js-reload="field_17_18" ><label class='gfield_label gform-field-label' for='input_17_18'>Where did you hear about this toolkit?<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_text'><input name='input_18' id='input_17_18' type='text' value='' class='large' tabindex='21' aria-required="true" aria-invalid="false" /></div></li><li id="field_17_14" class="gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible" data-js-reload="field_17_14" ><label class='gfield_label gform-field-label' for='input_17_14'>Zip Code/Postal Code<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_text'><input name='input_14' id='input_17_14' type='text' value='' class='large' tabindex='22' aria-required="true" aria-invalid="false" /></div></li><li id="field_17_12" class="gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible" data-js-reload="field_17_12" ><label class='gfield_label gform-field-label gfield_label_before_complex' >What best describes your connection to mentoring?<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_17_12'><li class='gchoice gchoice_17_12_1'> <input class='gfield-choice-input' name='input_12.1' type='checkbox' value='Mentor to one or more young people' id='choice_17_12_1' tabindex='23' aria-describedby="gfield_description_17_12"/> <label for='choice_17_12_1' id='label_17_12_1' class='gform-field-label gform-field-label--type-inline'>Mentor to one or more young people</label> </li><li class='gchoice gchoice_17_12_2'> <input class='gfield-choice-input' name='input_12.2' type='checkbox' value='Staff at a mentoring program' id='choice_17_12_2' tabindex='24' /> <label for='choice_17_12_2' id='label_17_12_2' class='gform-field-label gform-field-label--type-inline'>Staff at a mentoring program</label> </li><li class='gchoice gchoice_17_12_3'> <input class='gfield-choice-input' name='input_12.3' type='checkbox' value='Policy maker/government' id='choice_17_12_3' tabindex='25' /> <label for='choice_17_12_3' id='label_17_12_3' class='gform-field-label gform-field-label--type-inline'>Policy maker/government</label> </li><li class='gchoice gchoice_17_12_4'> <input class='gfield-choice-input' name='input_12.4' type='checkbox' value='Educator' id='choice_17_12_4' tabindex='26' /> <label for='choice_17_12_4' id='label_17_12_4' class='gform-field-label gform-field-label--type-inline'>Educator</label> </li><li class='gchoice gchoice_17_12_5'> <input class='gfield-choice-input' name='input_12.5' type='checkbox' value='Education adminstrator' id='choice_17_12_5' tabindex='27' /> <label for='choice_17_12_5' id='label_17_12_5' class='gform-field-label gform-field-label--type-inline'>Education adminstrator</label> </li><li class='gchoice gchoice_17_12_6'> <input class='gfield-choice-input' name='input_12.6' type='checkbox' value='Sports coach' id='choice_17_12_6' tabindex='28' /> <label for='choice_17_12_6' id='label_17_12_6' class='gform-field-label gform-field-label--type-inline'>Sports coach</label> </li><li class='gchoice gchoice_17_12_7'> <input class='gfield-choice-input' name='input_12.7' type='checkbox' value='Workplace supervisor' id='choice_17_12_7' tabindex='29' /> <label for='choice_17_12_7' id='label_17_12_7' class='gform-field-label gform-field-label--type-inline'>Workplace supervisor</label> </li><li class='gchoice gchoice_17_12_8'> <input class='gfield-choice-input' name='input_12.8' type='checkbox' value='Staff at youth development program' id='choice_17_12_8' tabindex='30' /> <label for='choice_17_12_8' id='label_17_12_8' class='gform-field-label gform-field-label--type-inline'>Staff at youth development program</label> </li><li class='gchoice gchoice_17_12_9'> <input class='gfield-choice-input' name='input_12.9' type='checkbox' value='Mentee' id='choice_17_12_9' tabindex='31' /> <label for='choice_17_12_9' id='label_17_12_9' class='gform-field-label gform-field-label--type-inline'>Mentee</label> </li><li class='gchoice gchoice_17_12_11'> <input class='gfield-choice-input' name='input_12.11' type='checkbox' value='Other' id='choice_17_12_11' tabindex='32' /> <label for='choice_17_12_11' id='label_17_12_11' class='gform-field-label gform-field-label--type-inline'>Other</label> </li><li class='gchoice gchoice_17_12_12'> <input class='gfield-choice-input' name='input_12.12' type='checkbox' value='N/A' id='choice_17_12_12' tabindex='33' /> <label for='choice_17_12_12' id='label_17_12_12' class='gform-field-label gform-field-label--type-inline'>N/A</label> </li></ul></div><div class='gfield_description' id='gfield_description_17_12'>Please select all that apply</div></li><li id="field_17_8" class="gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible" data-js-reload="field_17_8" ><label class='gfield_label gform-field-label' for='input_17_8'>Other:</label><div class='ginput_container ginput_container_text'><input name='input_8' id='input_17_8' type='text' value='' class='medium' tabindex='34' aria-invalid="false" /></div></li><li id="field_17_6" class="gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible" data-js-reload="field_17_6" ><label class='gfield_label gform-field-label' for='input_17_6'>If applicable, how many youth (age 6-24) do you or your program serve?</label><div class='ginput_container ginput_container_text'><input name='input_6' id='input_17_6' type='text' value='' class='medium' tabindex='35' aria-invalid="false" /></div></li><li id="field_17_9" class="gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible" data-js-reload="field_17_9" ><h2 class="gsection_title"></h2></li><li id="field_17_10" class="gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible" data-js-reload="field_17_10" >MENTOR National and Affiliates will use the information you provide to better inform future publications and keep you up to date with advancements in the mentoring field. 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