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.
YesNo
Email:*
example@example.com
MaleFemale
YesNo
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:*
YesNo
Academic FacultyAdministrative FacultyClassified StaffStudent WorkerOther
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.
YesNo
If Yes, please provide details:*
YesNo
YesNo
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:
Should be Empty:

References

Certification and Acknowledgment