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Mentor Interest Form
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* Required
Email
*
Your email
Name & Phone Number
Your answer
What Type of Non-Profit are
501c(3)
State Level
Community Group
Invidivdual w/ Curriculm/Testimony
Clear selection
Is your Organization/ Program insured?
Yes
No
Clear selection
Social Media Handle
Your answer
Are you only interested in being a mentor that floats or assist a teaching mentor?
Float
Assist
Both
Clear selection
Do you have your own curriculum or would like us to find you something to teach?
Yes
No
Clear selection
Do you need help organizing your material?
Yes
No
Maybe
Clear selection
What type of setup do you need?
Your answer
What materials do teens need?
Your answer
Briefly describe your program, Curriculum goal
Your answer
Do you market your program yourself?
Yes
No
Clear selection
How is success measured? i.e do teens received certificate etc..
Your answer
What days a week?
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
What is time of the class?
Time
:
AM
PM
Are you willing to pay $20 for the background? (We are only looking for violence or sex offense against children.)
Yes
No
Clear selection
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