Name of Applicant
*
First Name
Last Name
Gender
Race/Ethnicity
Birth date (must be at least 21 years of age).
*
-
Month
-
Day
Year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Title/Position
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Please select which area you would like to mentor in.
*
Academic Support
Life Skills Development
Career/Entrepreneurship Training
College Prepartion
Other
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?
*
Yes
No
Can you commit to meeting your mentee for a minimum of 45 minutes twice a month?
*
Yes
No
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?
*
Yes
No
Please list any states that you lived in outside of Washington State.
*
Please provide any other information you believe would be important in review of this application.
What extracurricular activities have you been involved in?
References
Three references that speak to your mentor qualities.
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
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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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