Mentor Application for University and College Students

Name(Required)
Address(Required)
Email(Required)
Please mark your primary campus affiliation:(Required)
Were you in 4-H?(Required)
Are you completing this program for a course, internship, or practicum?(Required)
How many hours and credits are you seeking from this experience from September 2023 to May 2024?(Required)
Please select all that interest you.
Please include Employer or Organization, your position title or volunteer role and year.
Which categories of civic engagement do you have background knowledge and you may be interested in serving as a mentor?(Required)
Check all that apply.
Indicate that you have read and agree with the Mentor Role and Expectations.(Required)

Visit the Mentor Role and Expectations page for more information regarding what is expected of a Mentor.

May we contact other references suggested to us in the course of contacting the references listed above?(Required)
Please note: information received from any references will be considered as a part of your application.
Have you ever been convicted of any crime other than a minor traffic violation?(Required)
I authorize contact of listed references. I understand that misrepresentation or omission of facts requested is cause for non-appointment or termination as a Cooperative Extension volunteer. I agree to abide by the expectations of Cooperative Extension and to fulfill the volunteer responsibilities to the best of my ability.(Required)
Please type your first and last name; understand that typing your name constitutes a legal signature confirming that you acknowledge and agree to the above statement.

Visit Page Mentor Application for University and College Students