Nominate

Together our goal is to empower individuals to become confident, self-sufficient role models, leading to economic and social well-being. Our greatest success stories are those who amplify the ripple effect of our support and pay it forward by creating opportunities for others. Those who receive support from the Mentors Foundation are responsible for working with their mentor and the Foundation to maximize the experience and ensure their success.

Potential mentor-nominators include teachers, coaches, counselors, and community leaders. Family members are not eligible to nominate.

In accepting support, the nominator agrees to fulfill the following responsibilities during their partnership with the Mentors Foundation:

- - Nominate someone who would fulfill the mission of Mentors.
  - Assist the mentee in completing required forms and responsibilities.
  - Provide mentee guidance and support throughout their engagement with Mentors.

Mentors Foundation is a partnership with shared responsibilities between the mentee, the mentor, and the Foundation.

Note: Both the application and nomination forms must be submitted three weeks before the due date.

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Name

First

Last

Address

Address Line 1

City

State

Zip Code

Have you nominated someone for Mentors Foundation support before?

Mobile Phone

If so, what was awarded?

Name of mentee you are nominating?

First

Last

Is your mentee applying for a

what you goal,

How do you know the nominee?

Based on what you know about this person's goal, what is the best way Mentors can provide assistance? Be specific.

We empower people to support themselves. How will Mentors assistance allow this person to become more self-sufficient?

I agree to mentor this individual through the duration of their relationship with Mentors Foundation.

Signature (Sign with finger or mouse)

Clear Signature

The information contained herein is true and accurate to the best of my knowledge. Please note while we strive to support as many applicants as possible we are unable to fulfill every funding request. Our decisions are guided by our mission, available budget, and alignment with our core objectives.

Date