YouthNet Summer Internship Mentor Program Interest Form (Mentor)
Thank you for your interest in mentoring a student in the YouthNet Summer Internship Mentor Program. Please complete the following questions so we can best match a student intern for this year's program. You may be asked to meet with a group of interns to describe your organization. Once matched with an intern, you will be asked to maintain an attendance record and complete a brief evaluation of your intern and this program. Questions? Email internship@somayouthnet.org

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Email *
Organization Name *
Division/Department (if applicable)
Mailing Address
Contact Person
Contact Person Title/Role in Organization
Contact Phone- Primary
Contact Phone- Cell
Email Address
Organization Website 
Organization Social Media (FB page, Instagram, etc)
Will you supervise the intern? If no, please include Contact information of the person responsible (Name, Primary Phone, Cell Phone, Email)
Please describe student responsibilities during the internship
Please check REQUIRED skills/qualifications
Please check PREFERRED skills/qualifications
What is your earliest START date?
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DD
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YYYY
What is your latest END date?
MM
/
DD
/
YYYY
Please check availability
How many hours per day will you use an intern?
Clear selection
How many days per week will you use an intern?
Clear selection
How long will you use an intern?
Clear selection
Will this internship offer a stipend or salary?
Clear selection
If Yes, what is the stipend amount or hourly rate of pay?
Would you be interested in hosting more than 1 intern?
Clear selection
Submit
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