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First Person
General Info
I am going to be a:
*
Mentor
Net Buddy
Guest
First Name:
*
Surname:
*
System Generated:
Alternative Email:
NickName:
*
Gender:
*
Male
Female
Non-Binary
Prefer not to specify
Password:
*
Confirm password:
*
Your Headline that everyone will see
on the Ezomndeni Net beneath your photo:
Miscellaneous Info
Birthday Month:
*
Select it
1
2
3
4
5
6
7
8
9
10
11
12
Birth Day:
*
Select it
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Birth Year:
*
Select it
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
1919
1918
1917
1916
1915
1914
1913
1912
1911
1910
1909
1908
1907
1906
1905
1904
1903
1902
1901
1900
Date of birth:
*
City:
Country:
Select it
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
British Virgin Islands
Brunei
Bulgaria
Burkina Faso
Burma
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Islas Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern and Antarctic Lands
Gabon
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See (Vatican City)
Honduras
Hong Kong (SAR)
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, North
Korea, South
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Macedonia, The Former Yugoslav Republic of
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia, Federated States of
Moldova
Monaco
Mongolia
Montserrat
Morocco
Mozambique
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestinian Territory, Occupied
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russia
Rwanda
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
Spain
Sri Lanka
Sudan
Suriname
Svalbard
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
The Bahamas
The Gambia
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Yugoslavia
Zambia
Zimbabwe
Postal Code:
Telephone:
Time Zone:
Select it
Africa/Johannesburg
US/Alaska
US/Aleutian
US/Arizona
US/Central
US/East-Indiana
US/Eastern
US/Hawaii
US/Indiana-Starke
US/Michigan
US/Mountain
US/Pacific
US/Samoa
Europe/Amsterdam
Europe/Andorra
Europe/Athens
Europe/Belfast
Europe/Belgrade
Europe/Berlin
Europe/Bratislava
Europe/Brussels
Europe/Bucharest
Europe/Budapest
Europe/Chisinau
Europe/Copenhagen
Europe/Dublin
Europe/Gibraltar
Europe/Guernsey
Europe/Helsinki
Europe/Isle_of_Man
Europe/Istanbul
Europe/Jersey
Europe/Kaliningrad
Europe/Kiev
Europe/Lisbon
Europe/Ljubljana
Europe/London
Europe/Luxembourg
Europe/Madrid
Europe/Malta
Europe/Mariehamn
Europe/Minsk
Europe/Monaco
Europe/Moscow
Europe/Nicosia
Europe/Oslo
Europe/Paris
Europe/Podgorica
Europe/Prague
Europe/Riga
Europe/Rome
Europe/Samara
Europe/San_Marino
Europe/Sarajevo
Europe/Simferopol
Europe/Skopje
Europe/Sofia
Europe/Stockholm
Europe/Tallinn
Europe/Tirane
Europe/Tiraspol
Europe/Uzhgorod
Europe/Vaduz
Europe/Vatican
Europe/Vienna
Europe/Vilnius
Europe/Volgograd
Europe/Warsaw
Europe/Zagreb
Europe/Zaporozhye
Europe/Zurich
Australia/ACT
Australia/Adelaide
Australia/Brisbane
Australia/Broken_Hill
Australia/Canberra
Australia/Currie
Australia/Darwin
Australia/Eucla
Australia/Hobart
Australia/LHI
Australia/Lindeman
Australia/Lord_Howe
Australia/Melbourne
Australia/North
Australia/NSW
Australia/Perth
Australia/Queensland
Australia/South
Australia/Sydney
Australia/Tasmania
Australia/Victoria
Australia/West
Australia/Yancowinna
Other Information
The industry that I work or would love to work in
(check all that apply):
*
Acting/Production
Agriculture
Art
Aviation/Pilot
Business
Childcare
Computers/Technology/IT
Construction
Engineering
Fashion/Design/Model
Farmer
Finance/Accounting
Food Service/Chef
Healthcare/Doctor/Nurse
Journalism/Writer
Law
Machine Repair
Manufacturing
Music/Singing
Personal Care/Hairdresser
Photographer
Religion
Retail/Shops
Sanitation/Cleaning
Sciences
Security/Police/Armed Services
Small Business Owner/Entrepreneur
Social Work
Stay at Home Parent
Teaching/Education
Transportation
None of the above
Pick the three best days of the week for video conversations
or coming to the mentoring lab:
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Net Buddies: Please choose the 3 best times after school or
on the weekend for your 30 minute video conversations:
*
1500-1600
1600-1700
1700-1730
1730-1830
1830-1930
Weekends 1200-1500
None of the above
Video Mentors: Please choose the best time of the day
for your video conversations:
*
08:00-08:30 ET
08:30-09:00 ET
09:00-09:30 ET
09:30-10:00 ET
09:00-10:00 ET
10:00-10:30 ET
10:30-11:00 ET
10:00-11:00 ET
11:00-11:30 ET
Weekends 06:00-09:00 ET
None of the above
Guest
Street Address:
*
School Name:
*
School Grade:
*
1st Parent/Guardian Name:
*
1st Parent/Guardian Surname:
*
2nd Parent/Guardian Name:
2nd Parent/Guardian Surname:
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