KidPOWER Mentor Application 2020-2021

CrossBRIDGE Requirements & Expectations for Mentors

At CrossBRIDGE, the mentor relationship exists within the context of our after-school tutoring and mentoring program, KidPOWER. CrossBRIDGE believes it is vital to maintain consistent and reliable volunteers, especially those in a mentoring role. Training will be provided and mentoring activities will be provided by CrossBRIDGE staff. We simply ask each mentor to make and keep the commitments outlined below. *This is an unpaid volunteering opportunity.
- Support CrossBRIDGE's KidPOWER Mentoring Program mission and values:
  - Our mission is to empower children to make positive life choices by providing a comprehensive program, teaching these six domains: purity in body and mind, service to others, wellness, academic excellence, and reconciliation.
  - We believe...
    
    In the power of God’s love and grace to transform lives
    
    Children are valued and loved by God and need to be loved by us
    
    Children need healthy, positive role models
    
    Positive reinforcement and redirection enhance learning
    
    Setting and enforcing boundaries prepares children for healthy relationships with God, self, and others
    
    Healthy confrontation is essential to a healthy relationship
- Follow all rules and guidelines as outlined by the program director, mentor orientation and training, and the Program’s Policies & Procedures
- Be flexible and provide the necessary support and advice to help the mentee succeed
- Make a one-school-year commitment to being matched with the mentee(s)
- KidPOWER Mentoring Format:
  - Mentor chooses mentoring day: Monday, Tuesday, Wednesday, or Thursday
  - Time: 4:30-6:00 PM
  - Location: Trevecca Community Church | 335 Murfreesboro Pike
  - Grade Levels Served: 1st - 4th
  - Agree to be matched with one to two mentee
- Be on time for scheduled meetings or notify the program leadership beforehand if unable to make a meeting
- If a meeting is planned to be missed for vacation, etc., try to reschedule within the same week
- Agree to a meeting - either in person or on the phone - with the program leadership once a month to discuss the match
- Inform the program leadership of any difficulties or areas of concern that may arise in the relationship
- Never be in the presence of the mentee when consuming, or have recently consumed, alcohol, tobacco, or controlled substances
- Notify the program leadership of any change in your contact information
- Attend mentor orientation and training
- Participate in match closure process at an appropriate time
- Must be 18 years of age or older
"By signing this document, I wholeheartedly agree to fulfill the program expectations and requirements listed above."
e-Signature *

KidPOWER Mentor Application

All information on this form is kept confidential. The information you provide may be used to match you with your mentee. Please complete the form in its entirety.
Name: *

First Name Middle Name Last Name
Mailing Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number: *

Area Code Phone Number
Personal Email Address: *
Please do not provide a school email address
Birth Date: *

Month Day Year
Gender
Estimated Graduation Date
Current Employer:

Criminal Background & Drug/Alcohol History
Have you ever used illegal drugs? *

Yes No
Please provide the month and year you last used. *
Are there any pending criminal charges against you? *

Yes No
Please explain. *
Have you ever been convicted of a felony offense? *

Yes No
Please explain. *
Have you ever been charged with child abuse? *

Yes No

References

Please provide the names and email addresses of three individuals who know you well and can attest to your character, skill and dependability.
Please do not list more than one relative as a reference.
REFERENCE #1: *

First Name Last Name
1. Name:
Email Address: *
E-mail:
How do you know this person? *
REFERENCE #2:

First Name Last Name
Reference # 2:
Email Address: *
E-mail:
How do you know this person? *
3. Name:
REFERENCE #3

First Name Last Name
Email Address: *
E-mail:
How do you know this person? *
Before submitting the application, please read the following statement carefully and sign below:

"I swear or affirm I provided accurate and complete responses to all information requested herein. I give my consent to CrossBRIDGE to confirm all information provided."
e-Signature: *
Today's Date:

Month Day Year
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CrossBRIDGE Requirements & Expectations for Mentors

KidPOWER Mentor Application