MY Project USA Mentor Intake Form

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Under MY Wing

College Student Mentor Form

Thank you for your interest in becoming one of our high-school-student mentors. Under MY Wing mentorship program envisions refugee and immigrant high school students that are prepared to pursue higher education in the United States of America.

First Name*

Last Name*

Cell Phone*

Home Email*

Address*

City*

State*

Zip Code*

Gender*

What is your age range?

18-24 25-34 35-44 45-54 55-64 65+

Ethnicity*

Somali Bantu Somali Other African American - New American Afro-American (Black) Asian Hispanic White Other

If Other, Specify:

Please answer all of the following questions:

1. Name of College or University you currently attend*

2. Year of study*

Freshman Sophomore Junior Senior Post-Graduate

3. Major*

4. Are you willing to take a background test as a necessary part of the onboarding process?*

Yes No

5. Are you able to commit 4 hours a week to this initiative*

Yes No

6. Hobbies & Interests*

7. What is your preferred mentoring location?*

Online In Person

8. Do you understand that all pictures and materials gained from this initiative are the property of MY Project USA?*

Yes No

A copy of your responses will be emailed to the address you provided.

Submit

Name
Address Line 1, Address Line 2
City, State Zip Code
Cell Phone
Contact Email

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Name
Address Line 1, Address Line 2
City, State Zip Code
Cell Phone
Contact Email

Facebook

Twitter

Instagram