SCOE Mentor Application

Volunteer Information

Name *

Full Name:

Date *

Today's Date:

Month

Day

Year

Department *

Department:

Supervisor *

Your Supervisor:

Contact Information

Work Phone *

Work Phone:

Cell Phone *

Cell Phone:

Emergency Contact Information

Name *

Emergency Contact Name:

Phone *

Emergency Contact Phone:

Mentoring Team Members

Mentoring Team Members (list names if you have a team)

Team Member Name 1

Team Member Name 1:

Team Member Name 2

Team Member Name 2:

Team Member Name 3

Team Member Name 3:

Bilingual Abilities

Languages

Languages Spoken: (Please specify if you can read and write in the language(s) you list)

School

Please select the school where you would like to mentor.

Schools *

Select one school from the list below.

Franklin Elementary - 120 S. Emerald Street

Muir Elementary - 1215 Lucerne Avenue

Shackelford Elementary - 100 School Avenue

SERVICES