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Apply to Mentor a 6th Grader

First Name / Last Name*     
Address*   
City*    Zip*     
Email*  
Daytime Phone*
Use format: XXX-XXX-XXXX		   Cell*       
Employer/School*   Dept.*   
Occupation*  
Why are you interested in becoming a mentor?*  
 
Please list your preference for placement by indicating 1st (1), 2nd (2), and your 3rd (3) choice. See map
    School Neighborhood       School Neighborhood
1 2 3  Allegheny 6-8 North Side   1 2 3  Arsenal 6-8 Garfield
 Wed. 3:30-4:45pm    Tues. 3:30-4:45pm
1 2 3  Schiller 6-8 North Side   1 2 3  South Brook Brookline
 Wed. Lunch time    Tues. 3:30-4:45pm
1 2 3  South Hills Beechview   1 2 3  Sterrett 6-8 Point Breeze
 Thurs. 10:00 am - 2:00pm    Wed. 3:30-4:45pm
1 2 3  Rooney 6-8 Brighton Hts.   1 2 3  Classical 6-8 West End
 Wed. Lunch time    Thurs. 3:30-4:45pm


To assist us in improving our recruitment efforts please let us know how you heard about The Career and Education Mentor Program:
Recruitment Presentation Intranet Posting School
Email Pittsburgh Cares Brochure
Place of Worship Workplace Billboard
Website Newsletter Television Station
Special Event Radio Station Newspaper
Mentoring Matters Comcast Mentoring Awareness Day    

© 2010 The Mentoring Partnership of Southwestern Pennsylvania

E-mail:
info@mentoringpittsburgh.org
Phone:
412.281.2535
Fax:
412.281.6683
Address:
2934 Smallman Street, 2nd Floor, Pittsburgh, PA 15201