2010-2011 Mentor Application Contact & Academic Information Name Street Address City, State Zip Code
E-Mail Address Academic Year
Availability Please mark ( X ) all times you are available (not in class or working) each day.
Monday Tuesday W ednesday Thursday Friday 9:00-12:00
Interest Essay Summarize why you would like to be a mentor with Bridges Beyond Borders. Please use only the space allotted (approximately 150 words).
Previous Volunteer Experience Summarize your previous volunteer experience, paying special attention to any international or youth
experience. Please use only the space allotted (approximately 150 words).
References List two references over the age of 21 and not related to you. Full Name
Relationship to You
Emergency Contact Name Street Address City, State Zip Code Home Phone W ork/Cell Phone
Recruitment Survey How did you hear about Bridges Beyond Borders?
Agreement Confirmation By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am selected as a mentor, any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal and replacement. Full Name Date
Our Policy It is the policy of Bridges Beyond Borders to provide equal opportunities without regard to race, color, religion, national origin, gender, sexual preference, age, or disability.
Thank you for applying to be a mentor with Bridges Beyond Borders and for your passion to serve the Lexington refugee community..
Please return this form as an attachment via e-mail to: Lindsay Griffith email@example.com Subject: Completed Mentor Application