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MENTOR APPLICATION
Applicant Information
Date of Birth
*
Social Security #
*
Name
*
Zip Code
*
Apt#
*
Address
*
Phone
*
Email
*
Guardian/Parent Information
1st Guardian/Parent Name
*
1st Guardian/Parent Phone
*
1st Guardian/Parent Email
*
2nd Guardian/Parent Name
2nd Guardian/Parent Phone
2nd Guardian/Parent Email
Teacher Reference
1st Teacher Name
*
1st Teacher Phone
*
1st Teacher Email
*
2nd Teacher Name
2nd Teacher Phone
2nd Teacher Email
Employment History
Position
*
Business Name (most recent)
*
End Date
*
Start Date
*
Why did you leave?
*
Manager's Phone#
*
Manager's Email
*
Manager's Name
*
Position
*
Business Name (2nd most recent)
*
End Date
*
Start Date
*
Why did you leave?
*
Manager's Phone#
*
Manager's Email
*
Manager's Name
*
Position
*
Business Name (3rd most recent)
*
End Date
*
Start Date
*
Why did you leave?
*
Manager's Phone#
*
Manager's Email
*
Manager's Name
*
Education History
Current/Highest Completed Grade
*
Select grade/degree
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Associate Degree
Bachelor Degree
Master Degree
Doctorate Degree
School Name
Current/Highest Completed Grade
Select grade/degree
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Associate Degree
Bachelor Degree
Master Degree
Doctorate Degree
School Name
*
Current/Highest Completed Grade
Select grade/degree
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Associate Degree
Bachelor Degree
Master Degree
Doctorate Degree
School Name
*
Tell Us More about You
Subject Interest
Select the participant's computer interest
Computer Repair/Design
Cybersecurity/Forensics
Project Management
Game Development
Computer Programming
Mobile App Programming
Web Programming
Administration/Infrastructure Design
Graphic Design
Music Producing
Aviation
Experience Level
Select the participant's level of computer experience
None
I've read a few books
I've taken classes on the subject
I experiment with the subject at my leisure
I have some professional experience
I currently work in the computer field
Computer Usage
How often does the participant use computers
Hardly ever
A few times per week
Daily at school/work only
Everyday; at work and home
Comments
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