YES! I'd like to be a mentor to a Yorktown student!
Please add me to the mentor bank. (I understand I may not be called immediately.)
| Name _________________________________________ | Daytime Phone ______________________ |
| Area of expertise ________________________________ | Evening Phone ______________________ |
| Occupation ____________________________________ | Email Address ______________________ |
| BusinessAddress ________________________________ | |
| __________________________________________ | |
| Home Address __________________________________ | |
| __________________________________________ | |
| Amount of time you can offer (once a week, every other week, limited number of meetings): | |
| ___________________________________________________________________________ | |
| Preferred ages: | Have you ever worked with young people before? _________________ |
| Preferred format (1:1, small group up to 4): | In what capacity?________________ |
| ___________________________________ | ___________________________ |
| When?________________________ | |
|
Do you currently have any children in the Yorktown schools? _________________ |
|
|
Which school(s)?_____________________________________ |
|
Please print and return the form to: Mentor Program Coordinator, Yorktown Central School District Mentor Program, 2723 Crompond Road, Yorktown Heights NY 10598