Become a MAS mentor

1.	First name*

2.	Last Name*

3.	Gender*
	Gender* Male Female

4.	Mailing address, city, state, ZIP*

5.	Phone number*

6.	Email address*

7.	Contact preference*
	Contact preference* Phone call Text message Email

8.	Highest level of educational attainment*
	Highest level of educational attainment* High school graduate Some college Associate and/or Bachelor's Degree Bachelor's Degree Master's Degree Doctorate or professional degree

9.	Preference of day (select all that apply)*
	Monday    Tuesday    Wednesday    Thursday    Friday

10.	Campus Selection #1*
	Campus Selection #1* Kashmere HS Wheatley HS Worthing HS

11.	Campus Selection #2*
	Campus Selection #2* Kashmere HS Wheatley HS Worthing HS

12.	I understand the need to maintain confidentiality regarding information that I might gain about students, families, and staff as I volunteer in the schools. I also understand that I am not to discuss individual student progress or behavior with anyone other than school personnel. I understand that if I violate school confidentiality rules, I may be asked to terminate my volunteer service.*
	Yes

13.	If I am selected to be a mentor I understand that my commitment involves spending a regularly scheduled time weekly at the assigned school with my mentee throughout one school year. As part of my participation in this program, I will communicate with the MAS program manager on a regular basis.*
	Yes

14.	Pursuant to Section 22.0835 of the Texas Education Code, I understand Houston ISD is required to conduct a criminal history review and reserves the right to receive and review any records maintained by any law enforcement agency.*
	Yes

15.	I hereby declare that all statements in this profile application are true and accurate.*
	Yes