Dismas House Mentorship Application

MENTOR APPLICATION

Thank you for your interest in becoming a Volunteer Mentor with Dismas House. We are so excited to have you join us. Due to safety precautions, we will not be holding in person trainings, however a training video and quiz will be emailed to you upon completing this form. Once you have completed the training, a member of our staff will be in touch!
Full Name *

First Name Last Name
Age *
Gender *
Race/Ethnicity *
Phone Number *
E-mail *
example@example.com
Please provide a personal reference:

Ideally, one personal reference who can attest to your attributes that would make you a good mentor for a resident at Dismas.
Reference Name *

First Name Last Name
Reference Email Address: *
Reference Phone Number *
In addition to a traditional mentorship relationship, we encourage peer mentoring relationships. Have you been convicted of a crime or have you been justice impacted? *

Yes No
If Yes, Please explain. This would not necessarily exclude you from mentoring in any way.

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MENTOR APPLICATION