New Mentor Registration Form

Pretty Brainy New Mentor Registration Form

Thank you for completing this New Mentor information! Once you have submitted the following and passed a background check, you will receive a link to attend New Mentor Orientation, a virtual event. The info you provide below will help us get to know you and pair you with the right mentees. Time needed for completion is about 10 minutes. If for any reason you need to step away, you can hit the "Save and Continue Later" button at the bottom of the page.

"*" indicates required fields

General

Name*

First Last

Choose your orientation date:*

Age range*

Email*

Mailing address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone number*

How did you hear about Pretty Brainy?*

Education & Professional Pursuits

I am currently in school*

Current level of study

School

Occupation and employer*

Major and major interests*

To make multiple selections, hold down the ctrl/cmd key while clicking on your selections.

Additional expertise

Health & Wellness

Dietary restrictions*

Choose all that apply

Gluten free

Dairy free

Vegetarian

Vegan

No restrictions

Other Restrictions

More About You

Please cite specific interests or area(s) of expertise within your field.*

If you teach, what do you feel most comfortable teaching?*

In what social and professional organizations do you participate?*

Please describe a time in life when you were young and faced an obstacle where you would have benefitted from having a mentor.*

Please describe characteristics of a successful mentorship.*

Background

Tell us about your previous volunteer experience.

Have you mentored before?*

Do you have a background check on file with any one of the following organizations? Poudre School District, Thompson School District, Weld District RE4, Colorado State University, Checkr.*

If no, Pretty Brainy will send you a secure link to complete a background check through Checkr.

Select the organization with which you most recently completed a background check.*

I hereby give consent to Pretty Brainy to photograph, videotape, or otherwise digitally record and use images and/or sound recordings of myself to use in any public media, including radio, television, internet, social media, print or in any of the organization’s or its partners’ publications, productions, or posts. I understand that the intended use of such images and information is solely for the purpose of advertising, marketing, fundraising and/or the promotional and public awareness purposes for the organization.*

YES

Typing your name in the field below constitutes consent to the Pretty Brainy Media Release policy.*

Name

This field is for validation purposes and should be left unchanged.

Pretty Brainy New Mentor Registration Form

General

Education & Professional Pursuits

Health & Wellness

More About You

Background

Title

About

Resources

Need Help?

Pretty Brainy^®

Pretty Brainy New Mentor Registration Form

General

Education & Professional Pursuits

Health & Wellness

More About You

Background

Title

Give Where It’s Needed Most

About

Resources

Need Help?

Pretty Brainy®

Pretty Brainy^®