Enrich Lives Mentoring Project

Name of Applicant*

First Name Last Name

Gender

Race/Ethnicity

Birth date (must be at least 21 years of age).*

Date

Address*

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Title/Position*

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

Please select which area you would like to mentor in.*

Based on your choices above, please describe the areas in which you can help provide mentoring.

Can you be a mentor for more than one person at the same time? If so, how many youth would you like to mentor?

Why are you interested in mentoring young people? *

Can you commit to being a mentor for at least one year?*

YesNo

Can you commit to meeting your mentee for a minimum of 45 minutes twice a month virtually?*

YesNo

It will be required to pass a background check and participate in a Zoom interview as a part of the mentor selection process. Are you willing to do both?*

YesNo

Please provide any other information you believe would be important in review of this application.

What extracurricular activities have you been involved in?

Name

First Name Last Name

Email

example@example.com

Phone Number

Please enter a valid phone number.

Name

First Name Last Name

Email

example@example.com

Phone Number

Please enter a valid phone number.

Name

First Name Last Name

Email

example@example.com

Phone Number

Please enter a valid phone number.

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By signing below, I commit to being a mentor for a minimum of one year to the Life Enrichment Group. I understand that submitting my application does not guarantee being selected as a mentor or being matched to a mentee.*

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References