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Mentor Intake Form 2023/24
East Tampa Youth Leadership & Entrepreneurship Academy
Academy Year
*
Choose one. Our year runs from June -> May
Mentor Name
*
Address
*
Phone number
*
Date of Birth
*
Email
*
Number of hours available each month for mentoring
*
Career/Expertise
*
Do you have previous experience as a Mentor?
*
How Long was your previous experience as a Mentor? (in years)
*
Please choose any of our monthly topics that you are interested in speaking about.
Select an option
Mentee Name
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Initial Contact w/ Mentee
Status
Additional information you would like us to know
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Drop files here
Onboarding
Orientation
Reason for No Contact about Exit
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