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Mentors
Contact at later date?
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First Name
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Last Name
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Gender
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Female
Male
Other
Prefer not to say
Combined Name Primary
Email Address
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Phone Number
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Textable?
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Yes
No
Alt. Phone Number
Alt. Phone Textable?
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Yes
No
Employer
Used for establishing corporate connections. This is NOT public.
Adult #2
Is there a second adult?
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Yes
No
Adult 2 First Name
*
Adult 2 Last Name
*
Adult 2 Gender
*
Female
Male
Other
Prefer not to say
Combined Name Secondary
Adult 2 Email Address
Adult 2 Phone Number
Adult 2 Textable?
*
Yes
No
Adult 2 Employer
Used for establishing corporate connections. This is NOT public.
Address
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Address
Address
Address
City
City
State
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State
Zip
Zip
I/My Family would like to work
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1-on-1 with an individual or family
as part of a team working with a family
Do you feel comfortable working with someone with limited English?
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Yes
No
Language(s) Other Than English Spoken
Arabic
Creole
Dari
Dioula
French
German
Hindi
Italian
Kikongo
Kinyarwanda
Kirundi
Kiswahili
Lao
Lingala
Moore
Portuguese
Punjabi
Russian
Somali
Spanish
Swahili
Tshiluba
Other
Do you have other skills/experience enabling you to advise or support our work?
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Case Management/Family Support
Education
Evictions
Housing - Locating
Housing - Landlord Issues
Legal
Mental Health
Nutrition
Social Work
Software/Technology
None of the Above
How would you describe yourself/your family including experiences with people from different cultures?
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Is there anything else you'd like to share about yourself or family?
*
How did you hear about Welcoming the Stranger?
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Brochure/Event
Friend/Relative/Acquaintance
Internet/Social Media
Newspaper
Organization
Radio/TV
Hear About Name
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Please list a Reference
Reference First Name
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Reference Last Name
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Reference Phone Number
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Reference Email Address
Relationship
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Acquaintance
Coworker
Friend
Relative
Comments
Welcoming the Stranger periodically follows up with mentors by email and/or surveys. We expect that you will respond.
Terms and Conditions
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I understand and accept the above conditions.
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