Lil' Jacob Learning Center

Community Mentor Application Form - Youth Outstanding Leadership Opportunity (YOLO) Mentoring Program

General Information

First Name	Last Name
Company/Organization/Faculty	Position
Address	City	State	Zip Code
Primary Number -	Secondary Number -
Primary Email	Secondary Email

Education Background

Previous Degrees/Diplomas/Skills (Please include your area(s) of concentration)

Career

What best categorizes your field?

Academic Administration

Business

Communications

Construction

Education K-12

Finance

Health Care Management

Higher Education

Law

Medicine

Mental Health

Non-Profit

Public Policy/Government

Publishing

Public Health

Research

Science

Social Services

Special Education

Technology

Publishing

Writing/Film/Art

Other

Years of experience in current field:

Please describe your job.
(Be as specific as you can; include title, areas of expertise, as well as your work environment)
What are your major career interests?
What are your career short and long term goals?
Hobbies and Interest
Please provide a brief description of your hobbies and interests
Please list the clubs, activities, and/or affiliations you belong to
Describe any special interests you would like to share For example: family life; ethnic, cultural, religious, and political interests; and volunteer activities.
How did you hear about the YOLO-Mentoring Program? A Friend Told Me A Co-Worker Told Me Recruited By A Staff Member Lil Jacob Website Washington Enterprise Website Brochure/Poster Other (please describe below)
Have you participated in the Mentoring Program before? No Yes If Yes, As A Student As A Mentor
Would your mentee be able to visit your workplace? No Yes
What are the best times for you to meet? Please check the times you prefer: Weekday Morning Weekday Afternoon Weekday Evening Weekend Morning Weekend Afternoon Weekend Evening
Would you be willing to mentor more than one student? No Yes
Would you like to part of Y.O.L.O. Job Shadowing Program? No Yes