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Minds Matter Application Form
Minds Matter Mentor Application
***Note: Minds Matter reserves the right to reject any applicant for any reason***
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* Indicates required question
Name
*
Your answer
Today's Date
*
Your answer
Date of Birth
*
Your answer
Home Address
*
Your answer
Work/School Email
*
Your answer
Non-Work/School Email
*
Your answer
Cell Phone
*
Your answer
Work Phone
Your answer
Best way to contact you
Work/School Email
Non-Work/School Email
Cell Phone
Work Phone
Background Information
What college(s) did you attend?
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Your answer
What did you major or minor in?
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List all majors and minors
Your answer
Where do you currently work / attend school?
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Company/school name and Title
Your answer
What is your previous work experience?
*
Your answer
Short Answers
Why do you want to get involved in Minds Matter?
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2-5 sentences
Your answer
Do you have any experience mentoring? If so, please describe what you did and for how long.
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2-5 sentences
Your answer
How did you find out about Minds Matter?
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2-5 sentences
Your answer
What are your interests?
*
Your answer
Have you ever been arrested? If yes, please explain.
*
Your answer
Are there any skills/talents you can bring to Minds Matter outside of mentoring?
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i.e. Web Design
Your answer
If selected as a mentor, how many years would you expect to stay in the program?
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Please indicate if you expect to leave Boston in the next 3 years
Choose
Less than 1 year
1 year
2 years
3 years
Greater than 3 years
Demographic Information
Age
*
Your answer
Gender
*
Choose
Male
Female
Ethnicity
*
Choose
Asian/Pacific Islander
Black/African American
Hispanic/Latino
White
Other
Prefer not to disclose
Did your parents attend college?
Choose
Both attended college/university
Only one attended college/university
Neither attended college/university
Prefer not to disclose
By typing in your full name below, you agree that you meet the following requirements: have an undergraduate degree, are 21 or over, and are available to mentor Saturdays from 11:30am to 2pm
*
Your answer
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