EmailMe Form - NSLC CMC/COB Mentor Intake Form

Name *

First Last

Email *

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Daytime Phone *

Evening Phone *

Best time to contact you? *

Spouse's Name *

First Last

Current Community (Surface, Aviation, Submarine, etc.) *

General Information

Have you attended the CMC/COB Command Spouse Leadership Course? *

Yes

No

If you have attended CLSC, when did you attend?

MM / YYYY

Please list locations and dates of current and prior CMC/COB commands. *

	Command Name	Dates
Current
Prior
Prior
Prior

Are you an active part of your current Command Support Team? *

Yes

No

What has been your involvement with your spouse's current and previous commands? *

What do you feel is your strongest point/passion with Navy Sailors and their families? *

Experience

Please list any past mentoring experience. *

Why do you want to mentor with CMCSLC? *

Please list two references: Name, Contact Number or Email. (must be CO/XO, their spouse or a current CMC/COB spouse). *

	Name	Contact Information
Reference #1
Reference #2

Thank you!

Thank you for taking the time to fill out the Mentor Intake Form. As mentoring opportunities become available, the Mentor Liaison or Steering Committee Director will be in contact with you.