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Mentor Applications
Step 1 of 2
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Name
*
First
Last
Date of Birth
*
Race/Ethnicity
*
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Cell Phone
*
Personal Email
*
Occupation
*
What is the best way to communicate with you?
*
Call
Text
Email
Do you have experience as a Mentor?
*
Yes
No
If you answered yes, how many years of mentoring experience do you have?
0-1
2-3
4-5
5-10
10-15
The purpose of mentorship is to teach, guide, provide advice and support to, and watch over and foster the progress of a mentee. What type of mentorship are you interested in with LPFLA? *Select all that apply
*
Individual Mentor- One on One with Mentee
Group Mentor- Scheduled with the cohort of young men (ie, expert presenter)
Co-Mentor- Paired with another mentor when assigned to a Mentee
How many events a month can you realistically commit to? Be mindful that weekend events can last between 3-4 hours.
*
1-2
2-3
3-4
4-5
What days are you available to mentor?
*
Weekdays
Weekends
Both
Can you commit to mentoring for at least one year?
*
Yes
No
Maybe
Why do you want to become a mentor?
*
What do you consider your greatest strengths that will help you make an impact as a mentor?
*
Did you have a mentor in your adolescent years?
*
Yes
No
What are some of your hobbies and interests?
*
What is the highest level of education you have completed?
*
High School or GED
Some College
Associate Degree
Bachelor Degree
Graduate Degree
Professional Reference
Name
*
First
Last
Phone
*
Email
*
Personal Reference
Name
*
First
Last
Phone
*
Email
*
Social Media Accounts
How soon could you begin mentoring?
*
Date Format: MM slash DD slash YYYY
Thank you for submitting your application to invest in the lives of our boys at LPFLA. Our team will reach out to you in the next 7-10 business days to update you on next steps. We thank you for locking arms with us to prove “mentorship matters”!
Email
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