National Disability Mentoring Coalition Membership Application

Thank you for your interest in joining the National Disability Mentoring Coalition (NDMC). Membership is open to any organization, business, or individual who shares core values and aligns with the NDMC's initiatives to streamline communication, standardize and systematize data collection, reduce duplication of efforts, increase mentoring opportunities, and improve outcomes for youth and adults with disabilities.

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* 1. Please share information about your organization/company.

Name: *

Organization/Company/Affiliation: *

Address:

City/Town:

State:

Zip Code:

Country:

Email Address:

Phone Number:

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* 2. Please share the name and website for your mentoring program (if applicable).

Name of Mentoring Program:

Website for Mentoring Program:

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* 3. Please describe your mentoring program or mentoring activities? (Demographics served, program model, and any other descriptive information that you would like to share)

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* 4. Describe the impact of your organization/company in terms of mentoring individuals with disabilities, if applicable. (numbers served, outcomes, etc.)

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* 5. Why does your company/organization want to join the NDMC? What do you hope to learn? How do you see your organization/company adding value to the membership?