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Mentor Application
For the Lunch Buddy Program
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* Indicates required question
Email
*
Your email
Option 1
Clear selection
Name (First, Last)
*
Your answer
Address
*
Your answer
Phone Number
*
Your answer
Additional Phone Number (optional)
Your answer
Workplace (if applicable)
Your answer
Emergency Contact, Name and Telephone Number
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Gender
*
Male
Female
Other:
Ethnicity
*
African American
Asian or Pacific Islander
Caucasian
Hispanic/Latino
Other:
Highest Level of Education
*
High School/GED
Certificate Program
Some College
Associate's Degree
Bachelor's Degree
Master's Degree
Doctorate
Other:
List Other Volunteer Experience (if applicable) including Organization, Position, and Dates of Volunteering
Your answer
Why are you interested in being a mentor?
*
Your answer
To assist in matching you with a student, please list at least three of your interests, hobbies, skills, or favorite things to do:
*
Your answer
Please select all days of the week that you would be available to be a lunch buddy:
*
Monday
Tuesday
Wednesday
Thursday
Friday
Required
Please specify what times you are available to be a lunch buddy (e.g. Only available from 12-1 pm) :
*
Any time between 10:30 am to 1 pm
Other:
School Preference
*
Arndt Middle School
Catawba Rosenwald Education Center (High School)
Grandview Middle School
Jacobs Fork Middle School
Maiden Elementary School
Mill Creek Middle School
Newton-Conover Middle School
Newton-Conover High School
Northview Middle School
Oxford Elementary School
River Bend Middle School
Snow Creek Elementary School
Startown Elementary School
No Preference
Other:
By submitting this application, you are committing to serve as a Lunch Buddy Mentor.
*
Yes, I understand and commit to the mentoring program.
No, I cannot commit to the mentoring program at this time but want my information on file for a later time.
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