LAEF Community Mentoring Program Helping Students Achieve through Higher Education Since 1949, LAEF has worked to improve access to higher education for Hispanic students. Join us as a Mentor and work with freshman LAEF scholarship recipients who have determination but may need an extra motivating force to encourage and assist them in planning their future. Please fill out the Mentor application form. Name: SSN: Address: City, State, Zip Occupation: Employer: Title: Work Address: City, State, ZIP: Home Telephone: Office Telephone: Pager or portable telephone: The best time and place to contact me is: Are you willing to meet with your student at least once a month (by phone, e-mail, or campus visit)? What distance are you willing to drive to meet with a student? What level of education have you completed and what school did you attend? Have you worked with students as a mentor in the past? Where? Do you have a criminal record?   YES   NO Do you now or have you in the past had a problem with alcohol or substance abuse?   YES   NO If you answered yes to either of the last to questions, please comment as an attachment. References (name and phone number) Friend: Relative: Co-worker: I am willing to serves as a mentor to an incoming freshman. I am able to contact or meet with a student once per month. I authorize and understand that a background check will be conducted by LAEF. LAEF is not responsible for any personal injury or material or monetary loss sustained by me while participating in the LAEF Community Mentoring Program. _________________________________________________________________ SignatureDate Please send this completed application and attachments to: Latin American Educational Foundation 561 Santa Fe Drive Denver, CO 80204