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About Us
Our Programs
Get Involved
Locations
Events
Contact
Donate

WANT TO BE A PART OF THE CHANGE?
Dare to Dream Mentor application

* Indicates required field

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Area(s) willing to serve (Check all that apply): *

Searcy Beebe Cabot Lonoke Conway Sheridan Pine Bluff Benton Bryant Jacksonville North Little Rock West Little Rock South Little Rock Midtown Little Rock

Would you be willing to travel up to 30 minutes? *

Email *

Phone Number *

Date of birth *

Gender *

Male Female Prefer not to answer

Have you ever served as a mentor before? *

Yes No

Have you volunteered in other youth-serving organizations? If yes, when and reason for leaving? *

Ethnicity *

Caucasian African-American Hispanic Asian Other

Education *

Some High School Completed High School Some College Associate's Degree Bachelor's Degree Master's Degree PhD

Employment *

Unemployed Part-time Full-time Self-employed

Employer/School Name *

Occupation *

Bio (background, life experiences, interests) *

Would you be willing to complete a background check (and if required by agency, CPR/First Aid Certification, fingerprinting, & TB testing)? *

Yes No

Would you be willing to provide references? *

Yes No

SKILLS, TRAINING, EXPERIENCE (Please check all that apply): *

Spanish-speaking Office/Clerical/Computer Musical Ability Education Military Background Math/Science Photography Sports/Athletic Media/Newspaper Fundraising Newsletter/Written Communication Public Speaking Business/Banking Medical/Medicine Sales/Marketing Arts/Drama/Dance Clergy/Ministry Law Enforcement/Judicial Counseling/Social Work Legal Nutrition Other skills, training and talents

Submit

IF YOU ARE UNABLE TO SUBMIT THIS FORM, EMAIL THE REFERRAL TO INFO@LITTLEROCKANGELS.ORG

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Contact Us

Phone: (479)799-1630
info@littlerockangels.org
P.O. Box 2703
Little Rock, AR 72203

WANT TO BE A PART OF THE CHANGE?Dare to Dream Mentor application

Stay Informed

Contact Us

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WANT TO BE A PART OF THE CHANGE?
Dare to Dream Mentor application