Mentorship Application

Name

Email Address

Contact Number

Mailing Address

How Did You Hear About Amped Kids?

Do you play any instruments, sing or compose music? If so, please elaborate below:

Have you ever worked with children ? If yes, please describe what role you were in.

Briefly explain what music means to you and how it has impacted your life.

Personal Reference Name, Number & Email

Personal Reference Name, Number & Email