Mentor Application
Name: *
Your answer
Birthdate: *
MM
/
DD
/
YYYY
Phone: *
Your answer
Email: *
Your answer
Home Address: *
Your answer
City
Your answer
State *
Your answer
Zip *
Your answer
Most recent employer and length of employment: *
Your answer
Do you have a current FBI/BCI background check on file? *
Are you willing to get one in order to become a mentor? (cost is on us) *
Please describe all previous mentoring or related experience you’ve had: *
Your answer
Can you commit to meet with a student for at least one hour weekly? *
Can you commit to be a mentor for at least 2 years? *
What meeting time(s) work best for your schedule? *
Required
How comfortable would you be working with a 9th grade student? *
I am uncomfortable.
I prefer working with this age.
How comfortable would you be working with a 10th grade student? *
I am uncomfortable.
I prefer working with this age.
How comfortable would be working with an 11th grade student? *
I am uncomfortable.
I prefer working with this age.
How comfortable would you be working with a 12th grade student? *
I am uncomfortable.
I prefer working with this age.
Are you willing to work with a child with disabilities? *
Next
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms