Mentor Application Form

Mentor Application Form
We are so excited to have you apply to be a mentor at Chica Project! Before you begin this application process please have a copy of your government issued ID, your completed CORI form ready to upload and a picture of yourself that you love.

Find more information about our Mentorship Program here.

If you have any questions, feedback or would like to schedule an information session about our Mentorship Program please contact Zaida Ismatul Oliva at zaida@chicaproject.org
- Name*
  
  First NameLast Name
- Preferred Name
- Pronouns*
  
  She/Her/HersHe/Him/HisThey/ThemAny
- Birthday
  
  MonthDayYear
  Date
- Race*
- Race (if more than one)
- Ethnicity*
- Language(s) you speak*
- What is your T-Shirt size
- Dietary lifestyle, restrictions and/or allergies*
- How did you hear about Chica Project?*
- Where are you currently in your career journey?*
- What field is your career in?*
- Tell us about yourself. What is your life journey, hobbies, and personal interests? *
- Please attach a photo of yourself*
  
  Cancelof
- Phone Number *
  Please enter a valid phone number.
- Email*
  example@example.com
- Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Why are you interested in becoming a Chica Project Mentor?*
- Do you agree to uphold and promote Chica Project's core values of power & potential, cariño & connection, radical authenticity, grace & intention, and the autonomy to redefine:*
  
  YesNo
- Chica Project Mentors communicate information via text and email. Do you consent to being added to the text thread? If not, you will only receive communicated information via email.*
  
  YesNo
- Committing to program(s) means you will attend at least 3 sessions in a school year. Does this work for your schedule?*
  
  YesNo
- If not, how many sessions can you commit to?
- Can you commit to attending at least 3 Chica Project events in a calendar year?*
  
  YesNo
- If not, how many Chica Project events can you commit to attending?
- Have you mentored with Chica Project in the past 2 years or have you submitted a CORI form to Chica Project in the past 2 years?*
  
  YesNo
- I understand that I need to complete and sign the CORI form with a government-issued ID in order to complete my commitment to being a Chica Project Mentor. By clicking yes, I attest to having completed this step.*
  
  YesNo
- Please attach your completed CORI form.
  
  Cancelof
- Please attach a government-issued ID. Examples are a driver's license, a state-issued ID, or a passport. Please ensure the ID you submit is not expired.
  
  Cancelof
- Name*
  
  First NameLast Name
- Phone Number*
  Please enter a valid phone number.
- Email*
  example@example.com
- Relation*
- Do you have any physical, mental, and/or medical conditions or special accommodations that we should know? Please tell us what you are comfortable sharing which will allow us to support you to the best of our ability.*
- Should be Empty: