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Mentor Registration
Needed for Mentors and Assistants
First Name
Last Name
Job Title
Employer Name
Phone
EMail Address
Assistant Status
Do not need an assistant
Bringing an assistant
Assisting a mentor
Name of mentor you are assisting
First time as mentor?
Yes
No
Required for Background Check Only
Date of Birth
Gender
Female
Male
Non-binary
Gender non-conforming
Other
Genderqueer
Transgender girl
Transgender boy
I choose not to respond
Gender Other
Program Description and Needs
Program Title (for brochure)
Program Description (for brochure)
Special Room Needs
Other Setup Instructions
Type of Volunteer Help Needed
Do not need volunteers
Need volunteer help - no age preference
Need adult volunteer helper
Need volunter help, prefer HS age
Class Size Limit - Leave blank or zero if not limited