WAM

Mentor Application

Name: First Last

Company or University:

Job Title:

Job Description:

Department:

Level of Education :

Street Address:

City: State: Zip Code:

Phone: work ( ) home ( ) cell()

Email:

T-shirt size (unisex) :

School Preference (hold down ctrl key for selecting more than 1):

What languages other than English do you speak:

How did you learn about the program:

Requirements

Do you have transportation to take two or three girls from school to a field trip?

Yes!
No

Pre-arranged field trips are usually scheduled weekdays late afternoon, requiring absence from school/work. From January through May, do you have time to take at least 1 day off (8am until 3pm) AND at least an afternoon/evening once a month?

Yes!
No

Comments