Mentoring Leadership Program-Mentee Application
Please complete this form to the best of your ability and submit once completed.

Operation Second Chance Mentor Leadership Program application for interested veterans looking for a mentor. Contact Katie Lintz (Program Advisor) at katie@operationsecondchance.org or at (224) 628-7171 for any questions or concerns. You will receive an email confirmation after you submit this application.

Email address *
Full Name (First, Last, MI) *
Your answer
Title *
Date of Birth *
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Gender *
Email Address *
Your answer
Phone Number; (Text Available? Y/N) Ex: "661-111-1111; Yes *
Your answer
Physical Address *
Your answer
Best way to contact you *
Desired start date *
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YYYY
Would you like to set an end of mentor-ship date? (Optional)
Please list all education both current and completed *
Required
MOS/ Job Specialty *
Your answer
Please indicate which branch of service you served in *
Time Spent in the Armed Services *
Your answer
Highest Rank attained *
Your answer
Shirt Size
Have you or your family members ever requested or received assistance from Operation Second Chance? *
Do you have any past criminal history or civil negligence charges that should be noted? If yes, please explain. *
Your answer
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