NSLC CO/XO Mentor Intake Form
  • Contact Information

  • Your address is required in order to receive course materials prior to the class.
  • Hold CTRL to choose all that apply. If choosing text message, ensure the phone number listed is your mobile phone.
  • Please answer this question if you selected phone call or text message. Hold CTRL to choose all that apply.
  • General Information

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  • You can upload your biography or enter text in the box below.
  • While it's not mandatory to provide a headshot, you have the option to upload one for use during your class.
  • Spouse Information

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  • Location Dates XO or CO?
  • Unique Experiences

  • (Your own spouse, other TRIAD members)
  • (Ailing family members, EFMP, new babies, left child(ren) in a different location, college students, etc.)
  • (Incomplete CST experiences, other CST challenges)
  • (Natural disaster, mishap, major injury, serious illness of command member or their family, loss of command member or their family, etc.)
  • (COMPASS, CORE, professional, community, etc.)
  • (Planning, organizing, presenting)
  • (Anything else you would like us to know)
  • 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.