Nevada Promise Scholarship Mentor Application

Your Legal Name:

First NameLast Name

Preferred Name:

First NameLast Name

Telephone Number:

Please enter a valid phone number.Format: 000-000-0000.

Would you like to receive program updates via text message to this number?

Email:

example@example.com

Gender:

Are you fluent in a language(s) other than English?

What Language(s):

How many students are you able to mentor?

We recommend committing to mentoring 4-5 mentees as some students will decide not to attend TMCC or may lose eligibility.

High School Attended:

Educational Attainment:

Post-Secondary Institution:

Post-Secondary Degree/Major:

Do you work at TMCC?

What type of TMCC employee are you?

Name of company you are currently employed at?

What is your job title?

Do you have an interest in working with specific student groups?

Example: Students in a technical program or first-generation college students.

Have you ever been charged/indicted for a felony?

If Yes, please provide details:

Are you 21 years of age or older?

Are you willing to undergo and provide all information required for a criminal history report?

How did you hear about applying to become a Mentor?

References

Please list two references below.

Reference #1 Name:

First NameLast Name

Reference #1 Email:

example@example.com

Reference #1 Phone Number:

Please enter a valid phone number.Format: 000-000-0000.

Reference #1 Profession:

Reference #1 Relationship:

Reference #2 Name:

First NameLast Name

Reference #2 Email:

example@example.com

Reference #2 Phone Number:

Please enter a valid phone number.Format: 000-000-0000.

Reference #2 Profession:

Reference #2 Relationship:

Certification and Acknowledgment

By submitting this form, I agree to allow TMCC to share my contact information with my Nevada Promise mentees and other relevant parties. I understand that when possible, mentors will be matched to mentees based on career interests, but due to the number of mentees, matching may need to be conducted on a first-come, first-served basis.

Please verify that you are human:

Sender Name: