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 AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest 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. Social Security Number For background checks and taxes. Please fill out a W-9 form and attach as a supporting document above.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 PhoneThis field is for validation purposes and should be left unchanged.