Mentor Application - Interest Survey
Please
Sign in to Google to save your progress. Learn more
Your First and Last Name *
Email Address *
Date *
MM
/
DD
/
YYYY
How did you hear about the Stay in School Mentoring Project (social media, community event, word of mouth, CCSD website / event ..... )? *
Will you be mentoring on the behalf /  under the name of any specific organization or company? If so name them below.  
What grade level(s) would you prefer to be matched with? *
Please check all that apply.
Required
What are the most convenient days for you to meet with your mentee? *
Required
What are the most convenient times for you to meet with your mentee? *
Please check all that apply.
Required
Preferred geographical areas of town *
Required
Do you have a specific school(s) that you'd like to mentor at? If yes please tell us the name(s) of the school(s) below.  
NOTE: We can't guarantee that you will be placed at your school of choice.
What jobs have you had, currently or in the past that may be of interest to a youth/young adult? *
Describe any hobbies, unique experiences or activities that you bring to a potential mentee. *
Please check all activities you participate in:   *
Required
List any other strong areas of interest.
 Any other information that would help us facilitate a relationship between you and a mentee:
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Clark County School District. Report Abuse
Google Forms