Refugee Mentor Interest Form
Welcome!

The Refugee Youth Mentorship Program matches refugee status youth between the ages of 15-25 with a caring member of the Tucson community to guide and support them as they pursue specific personal goals related to life skills, education, vocation, and social integration. The match is designed to last between 4-6 months, with an option to continue the mentoring relationship at the end of the term.

If you would like to become a mentor or are interested in finding out more about the program, please complete the following form!

With gratitude,

Brooke Balla
Program Development Coordinator + Outreach Specialist

bballa@lss-sw.org
Cell: (520) 343.4725
www.lss-sw.org/rymp

Name: *
Email Address:
Phone Number:
Home Address
Where did you hear about the Refugee Youth Mentorship Program? *
What is your age? *
What age group are you interested in mentoring? *
Which of the following most closely describe your current life stage?
In an effort to reflect the community we serve and diversify our mentor recruitment, please share your country of origin? *
Please select the Language(s) you are proficient in..... *
Required
Do you have a valid Driver's License and vehicle?
Clear selection
Do you have a Fingerprint Clearance Card? *
If you answered no to the previous question, would you be willing to obtain a Fingerprint Clearance Card?
Clear selection
Are you able to make a 4-6 month commitment to the program? *
When would you be interested in starting? *
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