California Mentor Form

Background Information
Full Name*

First NameLast Name
E-mail*
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Preferred method of contact*

CallTextEmail
School year*

High School FreshmanHigh School SophmoreHigh School JuniorHigh School SeniorCollege
School*
Major
Why are you interested in SHINE?*
Please list any relevant experience with dancing, working with kids, or teaching/tutoring math.*
How did you hear about the SHINE program?*
Availability
Are you available Saturdays at 9:30-12:30 starting on September 7-October 26, 2019?*

YesNoNot sure yetPartially
If partially available, please explain your availability:
Are you willing to interview for this position?*

YesNo
Are you interested in becoming a Lead SHINE Mentor?*

YesNoNot sure yet
Should be Empty:

Background Information