Interested Questionnaire
Please fill out, and send back, the following questionnaire prior to your interview.
Name:
Your answer
Nickname:
Your answer
Birth Date:
MM
/
DD
/
YYYY
Gender:
Ethnicity:
Address:
Your answer
Address2:
Your answer
City:
Your answer
State:
Zip Code:
Your answer
Phone number:
Your answer
Email:
Your answer
College Attending (if in college currently):
Your answer
Year in College:
Do you have your own reliable transportation?
Tell us why you would like to be a mentor/coach?
Your answer
Can you name a mentor/coach that influenced you and why?
Your answer
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