Interested in being a mentor? The LIFEGUIDE mentoring program is aimed at building life skills and community connections for foster youth ages 17-23 years old. You will be matched with a foster youth based on interests and preferences. You will meet weekly at an agreed upon location for the 12 week program. Mentors must be at least 25 years old for this program. Name* First Last DatePhone*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Email* Date of Birth* Current Profession (if not working, previous profession):*Company:*Position:*Education (Type, Degrees, Certifications):*Military experience?*YesNoIf yes, what branch?*Professional Affiliations:*Volunteer/Charitable Work:*What computer skills do you have (please check all that apply)?* Microsoft Word Excel Powerpoint Photoshop Access Garage Band or other recording program Web design Other None If other, what computer skills?What is the best time to meet with your mentee?* Weekday Mornings Weekday Afternoons Weekday Evenings Weekend Mornings Weekend Afternoons Weekend Evenings To help us match you with a mentee, we'd like to get to know you.What are your interests?*What is your favorite food?*What is your favorite place to eat?*What is your favorite travel destination and why?*Favorite TV show?*Favorite movie?*Favorite thing to do in your free time?*Favorite book/magazine?*What other languages do you speak?*Have you played sports?*YesNoIf yes, what sport(s)?*Have you played a musical instrument?*YesNoIf yes, what instrument(s)?*Please describe your personality (check all that apply):* quiet talkative outgoing moody cheerful nervous shy friendly analytical visionary artistic nurturing adventurous reserved other If other, please describe:*When mentoring, do you have a preference to the following?Gender*It doesn't matterYesIf yes, which gender?*FemaleMaleReligion*It doesn't matterYesIf yes, which religion?*Ethnicity*It doesn't matterYesIf yes, which ethnicity?*African-AmericanAsian-AmericanCaucasianHispanci/LatinoMulti-racialOtherIf other, which ethnicity?*Are there any personal qualities you prefer in a mentee?What areas are you willing to travel to mentor? Please check all that apply:* Sanford Oviedo Winter Springs Altamonte Springs Apopka Longwood Casselberry Orange City Winter Park Waterford Lakes Union Park Pine Hills Metro West Ocoee Winter Garden Downtown Orlando Dr. Phillips Kissimmee St. Cloud Poinciana Why do you want to be a LIFEGUIDE?*EmailThis field is for validation purposes and should be left unchanged.