Elder Mentor Application
First Name
Last Name
Preferred Name
Date of Birth
Phone
Email Address
Street Address/PO Box
City
Zip Code
Languages Spoken
What type of transportation do you typically use?
Car
ATV
Bus
Paratransit
Walk/Biking
What age group(s) are you most interested in working with?
Pre-Kindergarten (ages 3-4)
Grades K-3
Grades 4-6
Middle School
High School
Youth in community settings such as shelters, rehabilitation/correctional facilities, after school programs etc)
Why do you want to be an Elder Mentor?
What jobs or job have you held?
What hobbies or activities do you like to do?
What special skills do you have that you would like to share with youth?
Contact Information