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indicates required field |
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| Coordinator Login ID* |
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| Coordinator Password* |
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| Project Name* |
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| Street Address* |
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| City* |
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| State* |
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| Zipcode* |
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| County* |
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| Start Date* |
(mm/dd/yyyy) |
| End Date |
(mm/dd/yyyy) Please leave blank if there is no
end date. |
| Provide a brief description of the youth
participants in your mentor project (average age, spedific risks
identified, environmental issues, ect.)* |
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| Provide a brief project overview* |
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| Project Clearance
Information |
| What is the minimum age requirement to be
a mentor?* |
| How many mentor references are
required?* |
| Will your project do mentor
clearance?*
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| Will mentor DOJ clearance be
required?* |
| Will mentor FBI clearance be
required?* |
| Will mentor fingerprint be required?* |
| Will mentor driver license clearance be
required?*
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| Will proof of insurance be required?* |
| Will mentor DMV clearance be
required?*
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| Will mentor TB test be required?* |
| Will mentor training be required?* |
| Will sex offender search be
required?* |
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