Operation Second Chance Mentor Program - Mentor Application
Please complete this form to the best of your ability and submit once completed.

Operation Second Chance Mentor Leadership Program Application for interested mentors. 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 *
Gender *
Date of Birth *
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Email address *
Address *
Phone number; (Text Available Y/N) Ex: "661-111-1111 ; Y" *
Best way to contact you *
Earliest start date *
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YYYY
Would you like to set an end of volunteer service date? (Optional)
Please list highest level of education both current and completed *
Required
Federal/Civilian Employment experience? (Select all that apply) *
Required
If you selected Military, please indicate which branch.
Prior Service - Highest Rank attained in military service *
Required
Current Organization/ Employer* *
Position/Title *
Time spent in career field *
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 that should prohibit volunteer service? If yes, please explain. *
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