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
School year
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?
If partially available, please explain your availability:
Are you willing to interview for this position?
Are you interested in becoming a Lead SHINE Mentor?
Should be Empty:

Background Information