CH SURGE Mentor

SURGE Mentor Application

SURGE Mentor Application


Employment Information


Education Information


Next Step

Mentor Response


Please provide short responses to the following questions:

Mentors often have a particular set of experiences to share. Please help us achieve the best possible match between you and a mentee.

Please specify if there is a particular student you would like as your mentee.

Mentor Verification


I certify that the information I have supplied is correct to the best of my knowledge. I grant permission for you to contact the references provided. I also understand and agree to the duties and requirements described in the Volunteer Duties and Requirements.