Apply To Become A Mentor in our Civic Mentoring Program Applicant Name* First Last Applicant Home Phone*Applicant Cell Phone*Applicant Email* Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code How did you hear about Civic Mentoring?*Age & Level of Education*Can you provide us with some information on your abilities, interests and needs?*Please tell us anything about yourself that you would like us to know.If you wish, you may attach any relevant documents or a resumé. Drop files here or Select files Accepted file types: pdf, jpg, jpeg, doc, Max. file size: 50 MB. Emergency Contact Name* First Last Emergency Contact Phone*What mentoring sessions would you be available for?Mentoring sessions are two hours each and are scheduled Monday-Thursday and Saturdays or Sundays based on request and availability. Fall (September/October/November) Spring (February/March/April/May) Not sure Please download and sign the Terms of Agreement for the Civic Mentoring program. You may upload the signed form above, or mail it to the Sangha Education Center, 5 Old Jericho Turnpike, Jericho, NY 11753.Consent* I agree to the privacy policy.*Newsletter Yes, please sign me up for the Sangha Education Center newsletter EmailThis field is for validation purposes and should be left unchanged.