Mentor Application
A mentor is a loyal advisor, guide, confidant, and role model. They are a caring individual (other than the parent or guardian) who will help students with postsecondary college plans. Mentors will be part of a team who is supporting a young person through an ongoing, one-to-one relationship, and serve as a positive role model and friend. Mentors might help students explore career path, colleges, life skills, and communication etiquette. Or maybe it’s a trip to the theatre or dinner.
1. Name
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First Name
Last Name
2. Birthdate
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Month
-
Day
Year
Date
3. Upload resume
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Browse Files
Cancel
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4. Do you have reliable transportation?
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Yes
No
5. Do you have a driver's license?
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Yes
No
If not, why?
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Driver's license number
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Driver's license issuing state
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Please Select
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Driver's license expiration date
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Month
-
Day
Year
Date
6. Have you ever been arrested and/or convicted of a crime? Have you ever been convicted of a DUI?
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Yes
No
What were the circumstances? Please explain.
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7. Have you ever been investigated or convicted of child abuse or neglect?
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Yes
No
Please explain.
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8. Have you ever been investigated or convicted of sexually abusing or molesting a youth 18 or younger?
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Yes
No
Please explain.
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Place of Employment
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Position
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Email
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example@example.com
Phone Number
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Area Code
Phone Number
Is your phone number a home or mobile number?
Home
Mobile
Other
Home Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How did you hear about Waukegan to College?
Website/Social Media
School/Teacher
Family/Friends
Church/Congregation/Synagogue
Other
9. Why do you want to become a mentor at Waukegan to College?
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10. Do you have any previous experience volunteering or working with high school students? If so, please specify.
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11. What qualities, skills, or other attributes do you feel you have that would benefit a student? Please explain.
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12. The mentoring model we use is a long-term model. We would like for a student's mentor to stay with them until they graduate from college. Are you willing to make this long-term commitment?
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13. Are you available to meet with the student for a minimum of two times per month in person or virtually? Please explain any particular scheduling issues.
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6. If you had to describe yourself (select all which apply):
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Sport and Fitness: (Soccer, Basketball, Tennis, Swimming, Yoga, Cycling, Running, Hiking)
Creative Arts: (Painting, Drawing, Photography, Writing, Sculpture, Pottery, Graphic Design, Music)
Culinary Arts: (Cooking Baking, Cake Decorating, Wine Tasting, Food Photography, Recipe Sharing, Exploring new Cuisines)
Outdoor Activities: (Gardening, Birdwatching, Camping, Fishing, Nature Walks, Stargazing)
cat lover
foodie
health nut
traveler
movie lover
book worm
Other
6. How would you describe yourself as a person?
14. Every prospective mentor is required to complete a background check. Have you started this process yet?
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15. What are your interests and favorite activities?
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Rows
I'd like to try this!
I enjoy this!
This is my favorite!
Sport and Fitness: (Soccer, Basketball, Tennis, Swimming, Yoga, Cycling, Running, Hiking)
Creative Arts: (Painting, Drawing, Photography, Writing, Sculpture, Pottery, Graphic Design, Music)
Culinary Arts: (Cooking Baking, Cake Decorating, Food Photography, Recipe Sharing, Exploring new Cuisines)
Outdoor Activities: (Gardening, Birdwatching, Camping, Fishing, Nature Walks, Stargazing)
Technology and Gaming: (Programming, Web designing, Video games, App Development, Robotics)
Performing Arts: (Acting, Dancing, Singing, Improv, Theater, Stand-up Comedy, Musical Instruments)
Personal Development: (Mindfulness, Reading and book clubs, Personal Finance, Goal Setting, Time Management, Leadership Skill, public speaking)
Volunteer and Community Service: (Environmental Clean-ups, Animal Shelters, Homeless Shelters, Food banks, Fundraising events, Local Charities)
Travel and Exploration: (Sightseeing, Road trips, Backpacking, Cultural Festivals, historical landmarks, adventure activities - zip-lining, bungee jumping)
Academic Pursuits: (Science Projects, Research and Debates, History Discussions, Language Learning, Educational Podcasts and documentaries.)
16. Please expand on some of the interests that you indicated above.
17. Is there anything else you are interested in that the list doesn’t cover?
18. Is there anything you dislike or can’t do?
19. Is there anything new you have been hoping to learn to do?
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