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 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

Accepted file types: pdf, jpg, jpeg, doc.
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
Name
This field is for validation purposes and should be left unchanged.

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