Mentor Name (required)
Date (required)
Address (required)
Home Phone (required)
Cell Phone (required)
Email (required)
I am currently an active mentor and wish to continue with this student in the following school year.
If the box above was checked, enter scholar name here
I am currently an active mentor but wish to mentor an alternate student.
My current scholar is a senior, and I would like to take on a new student at the start of next school year.
I would like to be a "Mentor Buddy." Mentor Buddy is a new assistance program for new mentors. Each new mentor will be assigned a "Mentor Buddy" for assistance within their first three months, ideally assigned to the same school. A "Mentor Buddy" will be there to assist (if needed) with the first visit and/or be available to answer questions of the new mentor.
I am no longer able to mentor at this time, but retain my name for the future.
I am no longer able to mentor, delete my name off the mentor list.
I know a potential mentor! (potential mentor information below)
Potential Mentor Name
Potential Mentor Phone
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