Mentor 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) *
Title *
Date of Birth *
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Gender *
Email Address *
Phone Number; (Text Available? Y/N) Ex: "661-111-1111; Yes *
Physical Address *
Best way to contact you *
Desired start date *
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Would you like to set an end of mentor-ship date? (Optional)
Clear selection
Please list all education both current and completed *
Required
MOS/ Job Specialty *
Please indicate which branch of service you served in *
Time Spent in the Armed Services *
Highest Rank attained *
Shirt Size
Clear selection
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. *
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