Become a Mayor's Mentor

Thank you so much for your willingness to become one of the Mayor's Mentors. Mayor Alvin Brown has set an exciting goal of recruiting 500 in-school mentors by April 1, 2012 and your participation will helpour community achieve that goal. With the support of caring individuals, our children will not lose hope and will be encouraged to reach their full potential. Please remember, the difference between being a dropout and a graduate could be YOU!


Please fill out the brief questionnaire below and a member of the United Way of Northeast Florida staff will contact you directly to assist you in becoming one of the Mayor's Mentors.

 
 

Please enter the information indicated below.

 

By entering my personal information, I consent to receive email communications from the survey author's organization based on the information collected.

First Name:
Last Name:
Company Name:
Work Phone:
Home Phone:
Email Address:
emailaddress@xyz.com
Address 1:
Address 2:
City:
State/Province
(US/Canada):
Postal Code:

 Preferred Method of Contact:

 
Home phone
Work phone
Email
Other  


Gender:

 
Male
Female

 Languages:

 

 
English
Spanish
Other  

I learned about mentoring through:
(please check one)

 
Mayor's Mentors on COJ.net
United Way
Community/Corporate Presentation
My company is involved in mentoring
Referral from agency/organization
Mayor's Mentors supporting partners
Public service announcement
Newspaper, Television, Radio
Social Media
Other