Date of Birth
Are you a member of any professional, civic, or local community organizations? If so, please list them. If not, type N/A.
Have you ever served as a mentor?
Please list previous & current mentorship assignments. Include date, affiliation, etc.
Are you willing to undergo a background check?
Background check will be performed by an independent third-party entity.
Yes, I am
No, I am not
Level of Education
Select ALL that apply
Have you had personal or professional experiences with disabilities that you could share with participants? If yes, please describe.
Please indicate any special interest or background in science, technology, engineering, or mathematics
Do you have any hobbies or special skills that you think will benefit mentees?
Do you speak a language other than English? If yes, please list.
Mentoring a young person is a big responsibility and can change the lives of both the Mentor and the mentee. What do you hope to gain from the experience? What do you hope the mentee will gain?
Thank you for submitting your application to become a mentor! You will hear back from us soon. Sign up for our newsletter and come back and visit our website to get up to date information on what we are doing with our youth.
“Service to others is the rent you pay for your room here on Earth.”
— Muhammad Ali Pay Your Rent!