Become a Mentor - United Way of Palm Beach County

First Name*

Last Name*

Gender

Age

Phone Number*

Zip Code*

Email*

Preferred Contact Method*

Email or by Phone

* Racial/Ethnic Identity (for matching purposes only)

Racial/Ethnic Identity*

African American or Caribbean American

Asian

Hispanic/Latino(a)

White Non-Hispanic

Other

Are you able to make a year-long commitment (10-12 mo.) to a child?*

* Preferred Mentee Age Group (select all that apply)

Preferred Mentee Age Group (select all that apply)*

3-4 years old (only for mentors age 55+)

Elementary School (5-10 years old)

Middle School (11-13 years old)

High School (14-18 years old)

No preference

* Time Availability

Time Availability*

Weekdays during School (10am-3pm)

Weekdays after School (3pm-6pm)

Evenings or Weekends

If applicable, please select a specific mentee population that you would be interested in working with:

Any young person in PBC in need of a mentor

Level Up Program: Youth directly involved with or at risk of entering the Juvenile Justice or Dependency system. (You may be a good fit to mentor this population if you are an individual who has experience/involvement with the criminal justice system)

Youth on the Autism spectrum

LGBTQ Youth

Teen Mothers or Fathers

Youth in Foster Care (please note: 2 year commitment required)

Caregiving Youth

Other

Are you a seasonal resident?*

Only in Florida for part of the year (i.e. Winter)

How did you hear about United Way's Mentor Center?*

Why do you want to become a mentor?*

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