GEMS and GENTS Volunteer Application

Name
MM slash DD slash YYYY
Gender
Address
Employer Address
May You Be Called at Work?
Highest Grade You Completed
Have You Ever Been Convicted of a Crime Other Than a Traffic Violation?
A conviction would not necessarily bar you from participation in the program.
Do you object to our agency running a criminal background check on you?
Are you willing to commit to a minimum of 2 meetings per month with your mentee?
Please select the group(s) of students you would be interested in mentoring
Consent(Required)
Consent(Required)

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