1. Introduction and Contact Information

Mentoring programs serving Kenosha and Racine counties may register to become certified by completing the following application. The certification process is designed to ensure that mentoring programs for which MENTOR KENOSHA & RACINE is recruiting participants meet minimum standards based on research and best practices.

Once registered, a staff member from MENTOR KENOSHA & RACINE will review your application and contact your organization to schedule a presentation with the Advisory Board. The certification process is designed to ensure that your program meets the minimum criteria for MENTOR KENOSHA & RACINE.

Once certified, representatives of MENTOR KENOSHA & RACINE will actively recruit individuals and organizations to serve as mentors in your program.

Please begin by providing the following contact information for your organization's mentoring program.

* 1. Organization Name:

* 2. Mentoring Program Name:

* 3. Mentoring Program Contact Name:

* 4. Postal Address:

* 5. Phone:

* 6. Email:

* 7. Website (optional):