MENTOR APPLICATION
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Last Name:
*
First Name:
*
Middle Name:
Gender:
*
Male
Female
Phone (xxx-xxx-xxxx):
(Best # to reach you)
*
Email:
*
Home Address:
*
City:
*
State:
*
Zip:
*
Referred by:
Areas of Expertise/Experience:
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Automotive/Cars
Agriculture
Architecture and Construction
Art, AV Tech, Communication
Business Management
Education and Training
Finance
Government and Public administration
Health/Science
Hospitality and Tourism
Human Services
Information Technology (IT)
Law and Public Safety
Manufacturing
Marketing
STEM
Transportation, Distribution, Logistics
Please check all of the activities that interest you:
*
Art/Drawing
Automotive/Cars
Baking
Baseball
Basketball
Biking
Camping
Computers
Cooking
Exercise/Fitness
Football
Gardening
Making Crafts
Movies
Music
Photography
Reading
Sewing
Shopping
Skateboarding
Skating
Swimming
Soccer
Theater
Video Games
Other
Please describe your experience interacting with children:
*
Please indicate your mentoring level preference:
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Elementary
Middle School
High School
First Preference:
Second Preference
:
Cluster:
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Archer
Berkmar
Brookwood
Central Gwinnett
Collins Hill
Dacula
Discovery
Duluth
GSMST/Maxwell
Grayson
Lanier
Meadowcreek
Mill Creek
Mountain View
Norcross
North Gwinnett
Other
Parkview
Peachtree Ridge
Seckinger
Shiloh
South Gwinnett
Archer
Berkmar
Brookwood
Central Gwinnett
Collins Hill
Dacula
Discovery
Duluth
GSMST/Maxwell
Grayson
Lanier
Meadowcreek
Mill Creek
Mountain View
Norcross
North Gwinnett
Other
Parkview
Peachtree Ridge
Seckinger
Shiloh
South Gwinnett
*
I understand that I may gain information about a student that may be considered personal and confidential and should be treated accordingly. I agree that I will not disclose information obtained through my mentor relationship with a student to any third party who is not affiliated with the school. I further understand that any unauthorized disclosure of student information may be a violation of Georgia and Federal law.
Please choose your availability for an interview:
Mon
Tue
Wed
Thu
Fri
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PM
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PM
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PM
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Employed:
*
Yes
No
Are you a current GCPS Employee:
*
Yes
No
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