Mentorship Questionnaire

Tell Us About Your Current Situation

This form helps Pathway Humanity understand where you are, what support you may need, and what kind of plan would be most helpful for your next steps. Please answer as honestly as you feel comfortable.

First Name

Last Name

Email Address

Phone Number

City

Preferred Contact Method

What best describes your current situation?

What are the biggest challenges you are facing right now?

Select all that apply.

Stress or anxiety

Depression or low motivation

Substance use concerns

Unemployment or underemployment

Lack of structure or direction

Isolation or lack of support

Difficulty staying consistent

Transportation barriers

Financial stress

Do you currently have support in place?

What happens next?

Once you hit submit, our team will look over your answers and put together a personalized game plan just for you. We’ll include clear next steps and specific areas we can work on together to help you reach your goals!

Please select at least one current challenge.