2023 Mentor Application 1 Step 1 Choose the Play Like a Girl program to which you are applying:Meet + MentorLeadership AcademySTEM+ Challenge Contact Information First Name Last Name Cell Phone(555) 555-5555 Email[email protected]email Street Address Street Address City State Zip Preferred Communication MethodEmailSMS TextTelephone Personal Information Shirt SizeSelect An OptionAdult SAdult MAdult LAdult XLAdult 2XL GenderFemaleMale AgeSelect An Option18-2425-3435-4445-5455-6465+ Race or EthnicityAmerican Indian or Alaska NativeAsianBlack or African AmericanHispanic or LatinoMultiracialNative Hawaiian/Other Pacific IslanderWhiteUnknownOther, please specify If other race/ethnicity, please specify: Highest Level of Education CompletedSelect An OptionMiddle SchoolHigh School DiplomaVocational/Technical CertificateTwo-Year College (Associate) DegreeBachelor's DegreeMasters DegreeDoctoral Degree Marital Statuspick one!MarriedWidowedDivorcedSeparatedNever Married Employment StatusEmployed, full timeEmployed, part timeNot employedRetiredDisabled Title Employer Home OwnershipRentOwn Annual Household Incomepick one!Select An OptionLess than $20,000$20,000 to $34,000$35,000 to $49,000$50,000 to $74,999$75,000 to $99,999$100,000 to $149,999More than $150,000 Please rank the following social media sites in order of your usage, with 1 as the ‘most used' to 5 as the ‘least'.12345FacebookInstagramLinkedInTikTok Twitter How did you hear about Play Like a Girl?Select An OptionFacebookInstagramEmail/NewsletterWebsiteFriends or FamilySchool or TeacherOther OrganizationOther, please specify If other please specify Program/Match Information Have you participated in a Play Like a Girl program previously? *YesNo What sport(s), if any, do you currently play? *BasketballCheer or tumblingDanceFlag FootballGolfGymnasticsHockeyLacrosseSoccerSoftballTennisVolleyballNoneOther, please specify If other sport, please specify What was your favorite STEM-related subject in middle school?ArtCodingComputer ScienceDigital Citizenship Entrepreneurship MathematicsRoboticsScienceTechnology Please rank the program formats listed below in order of preference, with 1 as the ‘most preferred format, to 3 as the ‘least preferred format.123OnlineLive, In personHybrid (live and online) What is your current Time Zone?Pacific Mountain Central Eastern keyboard_arrow_leftPrevious Nextkeyboard_arrow_right Do you want to apply to be a Mentee? Apply here.
