Address: City:

State: Zip:

Email:

Academic background (units completed, colleges/universities
attended, areas of study, etc.)

Education work experience (experiences working with students
at any level, tutoring, teaching, mentoring, etc.)

Why do you want to be a 5C Experience Mentor?

What skills, abilities, talents, or experiences do you have
that will benefit the campers of the 5C Experience? What elective

classes are you willing to teach or create?

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