MENTOR INFO
ESSAY SUBMISSION
First Name
In 150 words or more please explain why
you would be a good mentor and what
skills, talents, interests, etc. you possess
that contribute to your role in the camp.
Last Name
Age
Male / Female
Street Address
City
State
Zip Code
Home Phone
#
(xxx)123-4567
E-Mail
PARENT/ GURARDIAN INFO
First/Last Name
Cell Phone #
Home Phone #
Relationship
REFERENCES
First/Last Name
First/Last Name
Phone #
Phone #
RACE (to be used for grant writing only)
Asian
Caucasian
African-American
Native-American
Hispanic
Multi-Racial
Other
Click
to download
Mail-In Application
MENTOR APPLICATION