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Sh’Shares Mentoring Program Application

Name:

I would like to HAVE / BE a mentor May we pair you with more than one person, if needed?: YES / NO
Have you HAD / BEEN a mentor in the past? Explain.

What would you like to contribute/gain from this experience?

Interests
1
Goals/Dreams 2
3
1
Strengths 2
3
1
Weaknesses 2
3
1
Likes 2
3
1
Dislikes 2
3
1
2011 “To-Do”
2
List
3

Education Level: School(s)/Major(s):

The religion bubble would be here, but… just don’t let your views
Marital Status: Children: hinder your interaction OR the interactions of others. Please and
Thank You! 
Interests/Hobbies:

Contact Information
Address:
City: State: ZIP Code:
DOB: Age: Email: Phone:

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