| Mentor Application
Name: Birth: Phone: Address: Highest Education: Occupation: Reason for applying: Mark (P) for project topics you would like to participate in and (L) for project topics you would enjoy leading: ( ) Culinary arts ( ) Cosmetology ( ) Fitness ( ) Meditation/relaxation ( ) Marketing ( ) Sales ( ) Business Planning ( ) Management ( ) Cultural Events Planning ( ) Awareness Campaigning ( ) Writing ( ) Film ( ) Music ( ) Acting ( ) Fashion ( ) Art ( ) Leadership ( ) Team/Trust Building ( ) Family Events Planning Experience related to mentoring, education, and supervising youth activities: Non-family references you have known for more than 1 year: Name: Phone #: Relationship: Name: Phone #: Relationship: Times generally available Sunday Monday Tuesday Wednesday Thursday Friday Saturday CPR Certified, if yes, what is the exp date: First Aid Certified, if yes, what is the exp date: Other Certification(s) and ex date(s): Health issues: Have you ever been convicted of a felony, if yes, explain: Will need a Background Check |
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| Updated 1/23/08 |
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