2018-2019 CREATE Mentor Registration
Thank you for your interest in serving as a Mentor with the CREATE Mentoring Program. Please complete all fields below, using N/A for any fields that you might not have an answer for.

For questions, please contact Katie Carbone at kcarbone@srbx.org or 916.465.8346.

Please note that serving as a Mentor with the CREATE Mentoring Program requires a minimum of two hours of volunteer time per month from September through April. Fingerprinting/Live Scan background checks are required prior to being able to serve as a Mentor.

First Name *
Your answer
Last Name *
Your answer
Company Name *
Your answer
Industry Type *
Required
Email Address *
Your answer
Preferred Phone Number *
Your answer
Preferred Phone Number Type *
Preferred Mailing Address *
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Gender *
Have you been a student in the ACE or CREATE Mentoring Programs before? *
Have you served as a Mentor with the ACE or CREATE Mentoring Programs before? *
If yes, how many years have you served as an ACE or CREATE Mentor? *
Your answer
Have you served as a Team Lead with the ACE or CREATE Mentoring Programs before? *
Are you interested in serving as a Team Lead with the CREATE Mentoring Program? *
Please select your first preferred school site: *
Please select your second preferred school site: *
Please select your third preferred school site: *
Please list any special accomodations *
Your answer
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