Mentor Profile Sheet

Date: ___/___/____

Name: ________________________________

Home Address: ______________________________

City: __________________________ State: ______ Zip: ____________

Phone: ______-_________ E-mail Address: ______________________

Male/Female: _______________ Ethnicity: _______________________

Employer: _______________________ Work Phone: ______-_______

Reference/Contacts:

Name: ____________________________ Phone: ( ____ ) ____-______

Name: ____________________________ Phone: ( ____ ) ____-______

Name: ____________________________ Phone: ( ____ ) ____-______

Hobbies/Interests: _____________________________________________________________

___________________________________________________________________________

Times available for meeting with mentee(specify if possible):

Morning: __________ Lunch: ________ Afternoon: ___________ Other: __________

Desired level/program: Book Buddy (GradesK-3/mentor 30min.per month) ____________
  Peer Pals (Grades 4-5/mentor 30 min twice a month) ___________
  Middle Ground (Grades 6-8/ mentor one hour weekly) _________

 


Matches with: ______________________________ Date of Match: ____/____/_____