APPLICATION DEADLINE: JUNE 1, 2019 (11:59PM)

Thank you for applying to be a Mentor with Evanston Scholars. We look forward to reviewing your application.

Applicant Information

First:

Middle:

Last:

Address & Contact Information

Street Address (Include Apt. No.):

City:

State:

Zip:

Email:

Home Phone:

Cell Phone (Personal):

Date of birth (mm/dd/yyyy)

Place of birth (city, state)

How did you learn about Evanston Scholars?

Current Employment Information

Company

Street Address

City

State

Zip code

Title

Phone

Personal Information

Ethnicity/Race:

Gender

FemaleMale

Educational Information

Name of High School

City

State

Undergraduate Institution

Major

Other Undergraduate Institution(s)

Degree(s)

Graduate Institution

Other Graduate Institution(s)

Degree(s)

Were you the first person in your family to attend college?

YESNO

Have you recently been through the college application process? If so, for whom and what colleges?

Please list languages in which you are fluent.

Why would you like to be an Evanston Scholars mentor?

What characteristics do you possess that would make you a good mentor candidate?

Have you ever previously mentored a youth or teen through a formalized program or worked with teens in another volunteer capacity? Please list the program(s) and the nature of your involvement.

Required Certifications

I certify that the information provided in this application is, to the best of my knowledge, true and correct. I have not knowingly withheld any facts or circumstance that could otherwise jeopardize consideration of this application. If selected as a mentor, I understand that Evanston Scholars will conduct a background check prior to my work with students.

Signature of Applicant

Date

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