Cornerstone Curriculum, Official Certification Edition - Mentor's Guide

M E N T O R N O T E S / 2 3

Personal Information

None of this data will be shared with your personal information attached. This is simply for data collection.

First Name:

Last Name:

Email Address:

Are you currently incarcerated (please circle one)? Yes / No

Sex/Gender (please circle one): Male / Female

Ethnicity (please select one of the following):

a. Asian/Pacific Islander

b. Bi-racial, Multi-racial

c. Black

d. Latino

e. Native American

f. White

Birth Year (e.g., 1976): _______

Thank you for completing this survey!