Online Mentor Application

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Online Mentor Application

Name:

Street Address:

City:

State:

Zip:

Male
Female

Driver's License:

Birth Date:

Email:

Home Phone:

Cell Phone:

Employer:

Work Phone:

1st Choice of High School:

2nd Choice of High School:

*Some Schools are no longer available as they have completely filled.

Please choose the appropriate training time based on your school of choice:

Thursday, September 10, 2009 from 5:30 p.m. - 7:30 p.m. (Austin-East, Central)
Tuesday, September 15, 2009 from 5:30 p.m. - 7:30 p.m. (Carter, Gibbs, South Doyle)
Saturday, September 19, 2009 from 9:00 a.m. - 11:00 a.m.
Thursday, September 24, 2009 from 6:00 p.m. - 8:00 p.m. (make-up)

*You must attend your designated training session to serve as a knoxAchieves mentor. All training sessions will be held in the Small Assembly Room of the City County Building.

Type in the case sensitive validation code.

The information I have provided is true to the best of my knowledge. I agree to allow the program to confirm all information listed and to conduct a criminal records check.

Applications must be submitted prior to the deadline.

400 Main Street, Suite 615 • Knoxville, TN 37902 • phone: 865.215.4754

Fourth Team Meeting
March 11, 2010
Fourth team meeting, March 1-March 26
Spring Break
March 29, 2010
Spring Break, March 29-April 5
Fifth Team Meeting
April 06, 2010
Fifth team meeting, April 6-April 30
ACT registration deadline
April 10, 2010
ACT registration deadline

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