Epic Girl

Mentor Application

* First Name

* Last Name

Preferred Name

* Email

* Address

* City

* State

* Postal Code

* Mobile Phone

* Are you 18 years or older?

* Birthday

Gender

* Employer

* Emergency Contact

* Emergency Phone

* Describe your formal/informal training and experience pertinent to the volunteer services you would provide.

* Other organizations to which you have provided volunteer services.

* When are you willing to volunteer? (days, times, dates)

* Have you ever been convicted of any criminal offense other that the following: Minor traffic violation of $500 or less; Offenses settled in juvenile court or under welfare your offender law?

* If yes to the previous question, please explain:

References

Reference 1 Name

Reference 1 Email Address

Reference 1 Phone Number

Reference 2 Name

Reference 2 Email Address

Reference 2 Phone Number

THANK YOU FOR APPLYING TO BE AN EPIC GIRL MENTOR.

We will be contacting you shortly to finish your application and get you started on your training classes. We can't wait!