Application

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
Basic
* Date of Birth
Demographic Information
* Gender
Availability
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
1. Before School
2. AM Block
3. Lunch
4. After School
5. PM Block
Education
School Name
Education Level
Other
Documents
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.