Village Impact Project Become a Mentor MORE ABOUT VIP Name(Required) First Middle Last Email(Required) Enter Email Confirm Email Date of Birth(Required) MM slash DD slash YYYY Gender(Required) Male Female Non-Binary Other Pronouns He/Him/His She/Her/Hers They/Them/Theirs Other Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone Number(Required)Can NCCJ text this number for VIP reasons?(Required) Yes No Drivers License Number Drivers License state Issued Ohio Other Times Generally Available for an interview(Required) Weekday morning Weekday afternoon Weekday evening Weekend morning Weekend afternoon Weekend evening Select all that applyRace/Ethnic Background(Required) African American/ Black Caucasian/White Latino/a Asian Pacific Islander Native American Multiracial Other Select all that applyMarital Status(Required) COVID-19 Vaccination Status(Required)Select from the dropdownFully vaccinated against COVID-19Will be fully vaccinated against COVID-19 before VIP activitiesNot vaccinated against COVID-19Why do you want to be a mentor?
