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mentor application form

Please complete the form below with thoughtful, complete sentences and paragraphs. We look forward to reviewing your application. You will receive a response confirming its receipt within the next two business days.





Home phone or cell phone number.






Please enter the high school from which you graduated. If no high school, please specify the path you took to a GED and the name of your local school district.








Please describe your experiences with leadership and/or mentoring.


Please list here two references we may contact. Include the following: first and last names, how long you've known the reference, the nature of your relationship (employer, pastor, supervisor, colleague, etc.), a phone number, and if possible, an email address.

By checking this box you assert that you are willing to submit to a background check if selected as a Rural Scholars Mentor.

By checking this box you assert that you will be the first generation in your family (including parents, step-parents, and legal guardians) to complete a four-year college degree.

 
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