Mentor Application First Name: * Last Name: * Email* DOB: * Select Gender: * Male Female Other Mobile No.* Home No. Address: * City: * Pincode: * Residence Location in Mumbai * 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
