Youth Mentorship Program Mentor Sign up form - 2022 Mentor Name Title First Name * Last Name * Suffix Mentor Address Address Line 1 * Address Line 2 City * State * Select option... Alabama Alaska Arizona Arkansas California Colorado Connecticut DC Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming DC Zip/Postal Code * Mentor Phone Number * Give a short paragraph on why you are interested in becoming a Lake County Mentor (200-500 words): * Please indicate which day and time you are available for your one-on-one meetings with your Mentee: * Monday - Morning Monday - Afternoon Monday - Evening Tuesday - Morning Tuesday - Afternoon Tuesday - Evening Wed - Morning Wed - Afternoon Wed - Evening Thursday - Morning Thursday - Afternoon Thursday - Evening Friday - Morning Friday - Afternoon Friday - Evening Meetings will be twice a Month*
