Welcome to the LifeSmart Education mentor application! Please fill in the following information to the best of your ability. 

Basic Information
* First Name
Middle Name
* Last Name
Email Address
Contact Information
Home Address 1
Home Address 2
Home City
Home State
Home Zip Code
Home Country
Home Phone
Mobile Phone
Work phone
Preferred Method of Communication
Home Phone Cell Phone
Work Phone Email
* Date of Birth
Demographic Information
* Gender
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
1. Before School
2. AM Block
3. Lunch
4. After School
5. PM Block
School Name
Education Level
Document Type 1 Other
Document Type 2 Other
Program Questions
* Do you have any experience working with youth? If so, please specify.
* What qualities, skills, or other attributes do you feel you have that would benefit a youth?
* What do you think will be the most challenging thing about being a mentor?
* What do you hope to gain from becoming a mentor?
Do you have social media? If so, please list below.
* How did you hear about LifeSmart Education?
If other, please specify.
Please list any prior volunteer experience.
* Have you ever been charged/indicted for any crime?
If yes, please specify.