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Mentor Application
Name
*
First
Last
Organization
*
Email
*
Which program stream are you interested in?
*
Mentorship
Mentorship + Internship
Why are you interested in becoming a Mentor?
*
Please provide a statement of interest in the box below that tells us a little about you and why you think you would be an excellent mentor.
What are some of your TOP ACHIEVEMENTS you would like your mentees to know?
*
Have you ever been a mentor?
*
Yes - formally
Yes - informally
No
How many hours can you dedicate to the program each month?
*
How would you like to interact with your mentees (Please check all that apply)?
*
In person
Online (Skype, Google Hangouts)
Email
Over the phone
What qualities do you look for in a mentee?
*
If you are selected for summer internship funding, describe what your intern will be working on.
*
Please provide a short description of the project(s) the summer intern will work on. (Ex. Creating a social media account for the organization and managing outreach campaigns...)
Proposed duration of internship
*
Start date of internship
*
MM slash DD slash YYYY
End date of internship
*
MM slash DD slash YYYY
Number of weeks of work
*
Number of hours of work per week
*
Acknowledgement
If you are selected to be a Mentor and/or host organization, you will be sent a Program Agreement that will outline further details of the program.
I understand that the program involves spending a MINIMUM OF TWO AND A HALF (2.5) HOURS EVERY MONTH.
*
Yes, I understand
I understand that the program involves spending a 20 hours per week to supervise the intern and a minimum of 2.5 hours per month for other mentoring activities.
*
Yes, I understand