P.H. Carmichael Foundation Mentor Application
The P.H. Carmichael Foundation prepares youth for college through a mentor program. Interested mentors should complete this form.
Applicant Information
Name *
First Last
Your answer
Email *
Your answer
Address *
Your answer
Phone *
(000) 000-0000
Your answer
Applicant Employer Information
Employer *
Your answer
Title/Position *
Your answer
Employer Address *
Your answer
Employer Phone *
(000) 000-0000
Your answer
Applicant College/University Information
Please list your undergraduate institution's information.
College/University *
Your answer
College/University Address *
Your answer
College/University Phone *
(000) 000-0000
Your answer
Degree/Major *
e.g. B.A. English
Your answer
Date Degree Earned *
MM/YYYY
Your answer
Other Education/Training
Institution, Degree/Certificate, Date(s)
Your answer
Applicant Organizations/Activities/Interests
Please list the names and date(s) of your previous and current affiliations.
Name and Date(s)
Your answer
Name and Date(s)
Your answer
Name and Date(s)
Your answer
Name and Date(s)
Your answer
Applicant Questionairre
The below questions are used to match mentors with scholars.
What previous and/or current experience do you have with mentoring youth? *
Your answer
What can you offer a scholar? *
Your answer
How much time are you willing to commit to working with a scholar? *
Your answer
Why are you interested in mentoring? *
Your answer
Applicant Demographic Information
The information below is used to match mentors with scholars and for foundation data. The P.H. Carmichael does not discriminate based on an individual's demographic profile.
Date of Birth
DD/MM/YYYY
Your answer
Gender
Select One
Race/Ethnicity
Select One
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