Mentor Application

To become a mentor, please download the PDF or complete the form below!

Mentor Application Hastings College

Work Email:

About You:

Name *

DOB *

Age *

School Address *

Permananet Address *

Phone *

Social Media Accounts *

What is your declared major *

What extra-curricular activities are you involved in *

Have you ever been convicted of a crime,If so, what was the crime and where did it occur *

List the address and phone number of two individuals who can serve as references for you. Please let them know that they will receive a phone call from our office.

Name *

Address *

Phone Number *

Relationship *
Name *

Address *

Phone Number *

Relationship *

I understand:

I, * ,certify that all the information in this application is true and complete to the best of my knowledge..

Mentor Signature*

Date*

Application Conclusion

Anti-spam Check *

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