If you are located in or near Lancaster County, Pennsylvania, please complete the following information. The data you provide will be forwarded to the Lancaster United Way Volunteer Center for review. Depending on your responses, the information will be shared with agencies that might match your interests and they will contact you directly. Thank you for your interest. Name:  Address:  City:  State:  Zip/Postal Code:  Home Phone:  Business Phone:  Email:  Tell us about you:  Why would you like to be a mentor?: What type of mentoring do you have in mind:    Unsupervised one-to-one    Unsupervised small group    Supervised one-to-one    (example: school-based tutoring)    Supervised small group    (example: youth community project)    Other (specify) Do you have any experience working with children? (please specify): How much time would you be able to spend with your mentee? Total number of hours per month Frequency:  Once a week  Twice a week  Once a month  More For what length of time might you be able/willing to make a commitment?  6 Months  Academic Year  One Year  More Prior to making a commitment, would you be interested in participating in a group activity with other potential mentors and mentees?  Yes  No Describe your vision of your "ideal" mentee: For a successful mentoring relationship, we'd like to match you with the program best suited to you and your interests. Please check the categories that best describe the child that you would like to mentor. If a category is unimportant to you, please check "Does not matter". I would most like to mentor: GENDER:  A Boy  A Girl  Doesn't matter AGE:  7-9  10-11  12-13  14-16  17-18  Does not matter ETHNICITY:  African American  Asian American  Caucasian  Hispanic American  Native American (American Indian)  Does not matter DISABILITY:  Yes  No  Doesn't matter