NE Key Mentee Application Question Title * 1. Contact Information Name Program Name Program Address Preferred Mailing address (if different from program address) City/Town State/Province ZIP/Postal Code Email Address Phone Number Question Title * 2. County of your Program Berks Bradford Bucks Carbon Columbia Lackawanna Lehigh Luzerene Lycoming Monroe Northampton Pike Schuylkill Sullivan Susquehanna Tioga Wayne Wyoming Question Title * 3. STARS Manager/Specialist Question Title * 4. How can you best be reached? Phone Email Skype, Facetime, ect. Question Title * 5. What time of the day are you available to work with a Mentor? mornings afternoon evenings Question Title * 6. What days of the week are you generally available to meet with your Mentor? Week Days Evening week days Weekends Question Title * 7. What would you like a Mentor to do? Help with starting a childcare business and becoming a STAR 1 Move up to a STAR 2 Move up to a STAR 3 Submit your application
