Preview Project Mentor Application Form

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ProjectChangeMentorApplication

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Instructions:Pleasefilloutacompletedformandsendtotheprojectdirector,KatieBliss,

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Process:ApplicationsarebeingacceptedonarollingbasisfromDecember2014‐March

2015.AdmittancetotheProjectChangementorcohortwillalsobedeterminedonarolling

basisduringthistimeframe.AllapplicationsareduebythesecondweekinMarch,andthe

finalselectionofmentorswillcommenceApril1rst.

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ImportantDates:Allapplicationsreceivedwillbereviewed,andapplicantswhoconveya

strongfitforthecurrentProjectChangestudentcohortwillreceiveaninterviewto

determinebestfitwithamentee.

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Disclaimer: All information provided is confidential and used only for the purpose of

matchingyouwithaProjectChangestudentformentoringattheCollegeofSanMateo.The

information you share will be usedtoprovidethemostoptimalmentee/mentor

partnership.

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VolunteerContactInformation

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Name:

____________________________________________________

First   Last

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Address:

________________________________________________________________________________

StreetApt.#CityStateZipCode

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BestContactNumber:(______)__________________

Email_________________________________

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Gender:M/F

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