NFB Link - Mentor Application

NFB Link - Mentor Application

Your Name:
Name Prefix *
First Name *
Last Name *
Middle Initial

Contact Info:
Address Line 1 *
Address Line 2
City *
State *
Zip *
Email Address *
Password *
Confirm Password *
Telephone number *
Telephone number (alternate)

General Information:
Date of Birth *
Occupation
Gender *

Blind or visually impaired?	Yes

Indicate highest degree earned: *
Ethnicity
List languages spoken other than English other than english

Membership:
What chapter do you belong to
State affiliate

Leadership:
	Local Chapter Officer State Affiliate Officer National Officer Committee/Division Chair

Mentoring Details:
Maximum number of people you would like to mentor at once: *
Areas of expertise you would feel comfortable mentoring others in:	Check all that apply: Accountants Architects Agriculturalists Automobile Mechanics Braillewriter Machinists Carpenters Chefs Child Care Professionals Computer Scientists Communication Professionals Culinary Professionals Customer Services Representatives Entrepreneurs Engineers Equestrians Finance Professionals Health Care Professionals Heating & Cooling Contractors Homemakers Human Service Professionals Journalists Legal Professionals Marketing Professionals Massage Therapists Music Technicians Musicians/Composers Nutritionists Orientation & Mobility Professionals Pet & Animal Service Professionals Plumbing Contractors Real Estate Agents Scientists Theologians Travel Agents Real Estate Agents Veterinarians Writers/Authors Woodworkers Administration Blindness Programs Specialists Executive & Managerial Professionals General Office Workers Public Employees Artists Artisans (crafts-people) Performance Artists Visual Artists Rehabilitation Professionals Administrators Counselors Teachers Trainers
Topics you would like to provide information on:	Check all that apply: Applying for College Assistive Technology Band Braille Choir Cleaning Cooking Doing Laundry Exercising Gardening Grocery shopping Home repairs Indoor and Outdoor Sports Knitting Operating a Telephone Personal Grooming Recording Devices Sewing Transportation methods Using Readers Woodworkers
Services you could provide information on:	Check all that apply: Library Services Newsline® Randolph-Sheppard Program Recordings for the Blind and Dyslexic Rehabilitation Issues Scholarships Special Education Social Security
People you would like to mentor:	Check all that apply: Students Senior Citizens Diabetics Guide Dog Users Individuals Seeking Career Advice Parents of Blind/visually impaired Children Parents Who Are Blind/visually impaired Veterans Multiply Disabled Deaf-Blind individuals Sighted Professionals (ophthalmologists etc.) Other
Please list any other interests or hobbies for which you would like to provide mentoring:
To help prevent automated submissions, please full in the current four digit year. *	yyyy
(* Denotes required field)