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Committed Coyotes
Community Mentor Questionnaire: Please fill out this form so we can match you with a student who has similar interests.
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* Indicates required question
Name
*
Your answer
Phone Number
*
Your answer
email address
*
Your answer
Address
*
Your answer
Why do you want to be a mentor?
*
Your answer
What are some of your interests?
*
Your answer
What can you share about your family life and background?
*
Your answer
If you are a female, what kind of little do you want?
Girl
Boy
Doesn't Matter
Clear selection
What grade level are you interested in?
*
Kinder
1st-2nd
3rd
4th-5th
Doesn't Matter
What school do you want to be matched at?
*
JKB
Rattan
Harlow
Doesn't Matter
How well do you like sports?
*
Not so much
1
2
3
4
5
A lot
How well do you like art?
*
Not so much
1
2
3
4
5
A lot
Playing board games?
*
Not so much
1
2
3
4
5
A lot
Reading?
*
Not so much
1
2
3
4
5
A lot
Math?
*
Not so much
1
2
3
4
5
A lot
Making or building things?
*
Not so much
1
2
3
4
5
A lot
Helping kids with academics?
*
Not so much
1
2
3
4
5
A lot
Will you be able to see your match at least once a week for 30 minutes?
*
Yes
No
What time are you available?
*
Your answer
Any questions?
Your answer
What Now?
After a background check, the school counselor from the campus you chose will contact you for further info and instructions.
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