Clarke County Mentor Program: Mentor Application

Personal Information

First name (legal) *This question is required.

Middle name

Last name *This question is required.

Preferred name

Date of birth (mm/dd/yyyy) *This question is required. This question requires a valid date format of MM/DD/YYYY.

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Driver’s license number *This question is required.

Driver’s license expiration date *This question is required. This question requires a valid date format of MM/DD/YYYY.

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If you said other, please specify

Do you speak Spanish? *This question is required.

Other language skills (please indicate language and level of proficiency)

Are you a UGA student? *This question is required.

Expected graduation date if you are a UGA student *This question is required. This question requires a valid date format of MM/DD/YYYY.

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UGA Greek affiliation

Do you play on a collegiate UGA sports team?

Your highest level of completed education *This question is required.

Current/previous involvement with the Clarke County Mentor Program *This question is required.

If you are currently a mentor, which school did you mentor at during the 2019-20 academic year?

General Information