Starfish Initiative Mentor Interest Form

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Email *

Today's Date *

YYYY

First Name (Legal name) *

Last Name *

Phone Number (with area code) *

Home Zip Code *

Employer Name (put N/A if not employed, retired, etc.) *

Employer Zip Code (put N/A if not employed, retired, etc.) *

How did you hear about Starfish Initiative? *

Web Search

Community Organization

Social Media

Employer

Personal referral

Other:

If you selected 'personal referral', please provide the name and company of the person who referred you:

Name (First & Last)

Company Name

Have you already gone through the Mentor Informational Session?

(In person Lunch-n-learn, virtual presentation, etc.)

Yes

Other:

We are offering options for mentoring. Please indicate which you would prefer. *

1:1 mentoring (1 adult with 1 student)

Small group (1 adult with 2 students)

Pairing with another mentor (2 adults with up to 4 students)

Other:

We also have other ways to volunteer with Starfish. Would you be interested in helping with one-time Starfish events (i.e. career fair, back to school kickoff, senior celebration, college fair/symposium)? *

Yes - you will be contacted to receive more details.

Maybe - you will be contacted to receive more information about events.

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