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S.T.Y.L.E. Mentor Information Release

Information Release 

1.I understand it will be necessary for S.T.Y.L.E. Mentoring Program to conduct a background check regarding my driving record, criminal history, personal references, and employment.  

I authorize S.T.Y.L.E. Mentoring Program to obtain any needed information regarding my driving record,  legal/criminal history, character references, and employment from any state or federal agency, my employer, and personal references for the purposes of participating in a  mentoring program. Further, I provide permission for S.T.Y.L.E. Mentoring Program to conduct the same investigation of my background in previous states in which I have resided. 

Once a mentor/mentee match is determined, my identity and any other information known about me may be shared with the mentee and parent/guardian to ensure and aid in facilitating a safe and successful match relationship. 
Date
2.Please complete the follow items:
3.Date of Birth
Date 
4.Current Driver's License Number  &  State
5.Please list any other cities, states, and dates of residency during the past 10 years.
6.Please type your name. This will represent your legal signature.(Required.)