Building Better Futures Englewood Mentorship Program Application

Building Better Futures Englewood Mentorship Program Application
This program is only open to residents of Englewood.

You are invited to apply for in an exciting NEW program that will introduce participants to many activities and individuals to help them define what their future will look like.

There are 24 sessions, that will be held during the next 5 months. Each session will last 2-3 hours.

Food will be provided during each session and everyone who completes the program will receive a stipend.

After reviewing the schedule and you feel this program is something you would like to participate in, continue reading and complete the requested information in this application.
Today's Date*

MonthDayYear
Date
Applicant Name*

First NameLast Name
Address*

Street Address

Community You Live In

CityState

Zip Code
Email
example@example.com
Phone Number*
Please enter a valid phone number.
Date of Birth*

MonthDayYear
Date
Date Today*

MonthDayYear
Date
Age*
Gender*

MaleFemale
You must fall into one of the following groups to participate. Please check which one.*

Actively involved in any street conflicts or neighborhood beefs.Recently been released from being incarcerated.If you or a family member is a victim of trauma related to violence (including gun violence or the loss of a close family member or friend due to gun violence).
Nationality *
Are you a permanent resident of the State?*

YesNo
Education
Highest Grade Level Completed*
Name of Last School You Attended*
Contact In Case of Emergency
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Acknowledgment
I understand that this is a personal development program.

I hereby declare that the information I have provided above is true and correct to the best of my knowledge. I understand that any misleading or false information I provide that was substantial to the consideration of my application shall cause the termination of my participation in the program. I understand that this is not an application for employment and neither does it serve to offer future employment.
Signature of Applicant*

Clear
Name of Parent/Guardian If Applicant is Under the Age of 18*

First NameLast Name
Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

Building Better Futures Englewood Mentorship Program Application

Education

Contact In Case of Emergency

Acknowledgment