Mentor Application

References
Please list the names, addresses, and phone numbers of three people you would like to use as character references (Please list only people you have known for at least a year. One should be a member of the Lenox Road Baptist Church.)
Reference #1
Name
First Last
Phone
Email
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Reference #2
Name
First Last
Phone
Email
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Reference #3
Name
First Last
Phone
Email
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Our program appreciates your interest in becoming a mentor to a youth/young adult. By hitting "Submit", you attest to the truthfulness of all information listed on this application. You agree to let our program confirm all information listed and to conduct a necessary background check. You also assert that "I have read and understood the program’s rules, regulations, and responsibilities for becoming a mentor. If selected, I will follow the rules of the program and be a dedicated mentor. I agree to the time commitment specified in the guidelines."

References