Apply to Become a TechGYRLS Mentor!

Contact Information
Name:
Address:
City:
State:
Zip Code: (5 digits)
Home Phone:
Cell Phone:
E-mail Address:
 

General Information
School/Company:
Date of Birth:
Do you have transportation? Yes No
 

References
Name:
Phone:
E-mail Address:
Relationship:
I grant permission to call the reference listed above.
 
Name:
Phone:
E-mail Address:
Relationship:
I grant permission to call the reference listed above.
 

Why are you interested in becoming a TechGYRLS mentor?

What experience do you have working with young people?

What would you bring to the TechGYRLS Club?

What computer/technology experience do you have?

It is required that any adult working with children complete a criminal record clearance form and a child abuse clearance form. A criminal history record can be completed at http://www.psp.state.pa.us/patch/site/default.asp and a child abuse clearance form can be found at http://www.dpw.state.pa.us/child/childabuseneglect/003671038.htm. These forms must be completed and submitted along with a $10 certified check or money order for each form if selected as a TechGYRLS mentor.

Consent Form

I, , an applicant for the TechGYRLS mentor position with the YWCA of Bethlehem, hereby attest that I have never been found guilty of, or entered a plea of nolo contendere (i.e. no contest) or guilty of a crime determined to be a misdemeanor or felony, including abuse or neglect against a child, or assault, theft, arson or possession of any drug.