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MENTEE APPLICATION

Are you a returning citizen who is interested in getting a mentor from the Second Chance Support Network?
Please fill out the mentee application below and someone from Second Chance Support Network will get in contact with you.

First Name

Last Name

Home Street Address

City

State

Zip Code

Date of Birth (MM/DD/YYYY)

Phone Number

Email

MDOC Number

Releast Date

Probation/Parole Agent:

Agent's Phone Number

Conviction(s):

Please List Any Special Parole/Court Conditions

Education Level

High School Dipolma/GED

Working on GED

College Degree

Graduate School

Techinal Training

Anticipated Completion Date for GED Program:

College Degree

List Technical Training Programs Completed

Do you have a valid drivers license?

Yes

No

Do you have transportation?

Yes

No

Previous/Current Religious Affiliation

How did you hear about Second Chance Support Network?

Thank you for submitting your application! Someone from the Second Chance Support Network will be in touch with you shortly.

The feeling of helping others and making a difference in our community is priceless.

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501(c)3 Non-Profit

Tax ID: 26-4314927

5840 Sterling Drive, Suite 130

Howell, MI 48843

(517) 586-4024

scsnlivingston@gmail.com

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MENTEE APPLICATION

Are you a returning citizen who is interested in getting a mentor from the Second Chance Support Network? Please fill out the mentee application below and someone from Second Chance Support Network will get in contact with you.

The feeling of helping others and making a difference in our community is priceless.

Are you a returning citizen who is interested in getting a mentor from the Second Chance Support Network?
Please fill out the mentee application below and someone from Second Chance Support Network will get in contact with you.