Youth Guidance

Aunts and Uncles Program

Mentor Application 2003/2004

Name ___________________________

Home Address ________________________

Home phone _______________________

Work Address________________________

email ________________________________

Occupation/ title ________________________

Employer ______________________________

Any similar mentoring experiences in your background?__________

_______________________________________________________

Interests/hobbies (for student matching) _______________________________________________________

_______________________________________________________

Languages other than English?_____________________

Do you prefer a male or female student? _________________

Please return this form to:

Patricia DeJean

Thank you!