Mentor Information (Required)

Mentor Home Address
Parent/Guardian #1 (Required)
Parent/Guardian # 2 (Required)
Community Service and Sports Information
Activities both on-campus and in the community
Additional Information
Also, let us know if other members of you family have worked with disabilities.
You will receive training before being assigned to a young child. You will be expected to spend at least 6-8 hours each month with that child.
This includes providing monthly information regarding your mentoring activities, and receive feedback regarding any difficulties during your participation in the mentoring program.
Meeting attendance is required before being matched as well as throughout the duration of your match.
Confidential Information 


If yes, please give the date(s), school, and circumstances.
Goals
Please provide three adult references for your recommendation.
Reference # 1
Reference # 2
Reference # 3
(e.g. friend or neighbor, outside of your immediate family whom we can contact for a character reference.)

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