MY Project USA Mentor Intake Form

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Under MY Wing

Professional Mentor Application

Thank you for your interest in becoming one of our professional 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*

Address*

Cell Phone*

Home Email*

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, Ethnicity, Please Specify:

Please answer all of the following questions:

1. Can you commit to 10 hours per month?*

Yes No

2. Do you agree to a background check?*

Yes No

3. How do you describe your skills set?*

If Other, Specify:

4. Will you be able to spend 1 hour with the mentees every week?*

Yes No

5. Will you be able to complete the feedback form after every session?*

Yes No

6. 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