Mentor Registration Form

1. Fill out this application.

2. Send this to:

Steve Borden
Mentor Coordinator BTM-MN
604 Thomas Ave S
Minneapolis, MN 55405

3. Call Steve at 612-867-4924 with any questions.

Name: ________________________________

Signature: ________________________________

Address: __________________________________________________________________________

Phone numbers: ____________________________________________________________________

E-mail Address: ___________________________________________

Social Security Number: ____________________________

Do we have permission to do a background check on you? ___ yes ___ no

I am applying for either/both ____Staff position ____ Mentor position (mentors have staffing priority)

Once you apply, we will send mentors an enrollment packet to be completed, or you can pick one up at one of our open houses.

Thanks.

Steve Borden
Mentor Coordinator BTM-MN
612-867-4924