Mentor Application

Personal

Your Name (required)

Phone Number (required)

Home Address (required)

State (required)

Your Email (required)

Current Employment

Title/Occupation

Employer Address

Employer State

Education

College Attended

College Location

College Degree(s) / Area(s) of Concentration

Year Graduated

Graduate School Attended

Graduate School Location

Graduate School Degree(s) / Area(s) of Concentration

Year Graduated

Please respond to the questions/statements below:

Why do you want to be a mentor?
What do you hope to gain and receive from serving as a Dream On Education Mentor?

If selected, will you commit to mentoring consistently for the entire academic year?

Please describe what you consider to be your strongest general competencies
(i.e. knowledge, skills and abilities).

Please describe what you consider to be your strongest technical competencies.

Please list any honors, awards, or positions that you’ve held/received.

Please list at least three hobbies/interests that you have outside of work.

Please list three words that describe you.

Please list two references (name, phone number, email)

Please list two contacts who have expressed interest in serving as a Dream On Education Mentor, Tutor, or Donor or who may be interested in volunteering with Dream On Education. (optional)