Mentor Application First Name: * Last Name: * Email* DOB: * Select Gender: * Male Female Other Mobile No.* Home No. Address: * City: * Pincode: * Residence Location in Mumbai * Please choose one... South Mumbai (Colaba to Byculla & Nariman Point to Mumbai Central) South Central Mumbai (Chinchpokli to Sion & Mahalaxmi to Mahim) North Central Mumbai (Kurla to Ghatkopar & Bandra to Vile Parle) North Mumbai (Vikhroli to Mulund & Andheri to Dahisar) Harbor South (CST to Wadala) Harbor North (GTB to Mankhurd) Navi Mumbai (Vashi to Panvel) MMR (Mumbai Metropolitan Extension Region) (Thane to Kalyan & Mira Road to Virar) Educational Qualification: * Occupation: * Name of the Organisation: * Occupational Address: * 1. What motivates you to become a mentor? * 2. What value do you feel you can add to your mentee? * 3. Please list any hobbies or interests you may have: * 4. What clubs or groups, if any, do you belong to within and outside of your college/workplace? * 5. Please select the activities you would enjoy doing with your mentee: * Playing Sports Discussing Current Affairs Writing Reading Photography Attending Plays Science Experiments/Field Visits Arts and Crafts Visiting Zoos and Parks Visiting Museums Playing with Computers/I-pads Playing Games Dance and Music Other 6. Do you have a past criminal record or have been tried in court for acts such as consumption of illegal substances, violence, abuse or other such punishable offence? Yes No 7. If your answer is Yes, please state in the nature of your criminal record / legal proceeding (including current status) 8. From where did you hear about The lighthouse Project? * Friends / Family News Articles Banner / Standee / Poster Event / Activity Website Facebook Twitter Instagram Any other I certify to the best of my ability that the information provided in this application is true and accurate. Send
