Mentor Application - Colorado "I Have A Dream" Foundation

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Email

Date of Birth

Employer/School Name, Address, and Phone Number

Education Completed*

High School
GED/Other
2-Year College
4-Year College
Advanced Degree (JD, MD, MBA, etc.)

Please check all boxes that apply for education you have completed.

Schools Attended and Degrees Earned

Please list all schools you have attended and the degrees earned.

What motivated you to apply to be a mentor?*

Will you be able to meet with a student at least once a week?*

Yes
No

What are your hobbies, special skills, or other interests?*

What other affiliations (e.g., service or volunteer organizations) do you have?

What do you hope to gain from the mentoring experience?*

What do you hope your mentee gains from the mentoring experience?*

If you have previous mentoring experience, please describe the experience below.

Mentors often have a particular set of experiences to share. Please help us achieve the best possible match by specifying if you would like to mentor a student from a specific cultural background (if available).

Bilingual

If you are bilingual, please indicate which languages you speak below.

Background Check*

Are you willing to have Colorado "I Have A Dream" conduct a background check on you, including fingerprints?

Yes
No

Application Certification

I certify that the information I have supplied is correct to the best of my knowledge.

Applicant Signature*

Please type your name below, indicating certify the information in this application.

Application Date*

Please type the date this application was completed.