Youth Guidance

    Aunts and Uncles Program

Mentor Application 2003/2004

 

Name ___________________________

 

Home Address ________________________

 

Home phone   _______________________

 

Work Address________________________

 

email ________________________________

 

Occupation/ title ________________________

 

Employer ______________________________

 

Any similar mentoring experiences in your background?__________

_______________________________________________________

 

Interests/hobbies (for student matching) _______________________________________________________

 

_______________________________________________________

 

Languages other than English?_____________________

 

Do you prefer a male or female student? _________________

 

 

 

 

Please return this form to:

 Patricia DeJean

         Fax: 312/253-4917  Phone: 312/253-4900

E-mail: pdejean@youth-guidance.org

122 S. Michigan Ave., Suite 1510 Chicago, IL 60603

 

Thank you!