Waukegan to College Mentor Application

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*

First NameLast Name
2. Birthdate*

MonthDayYear
Date
3. Upload resume*

Browse Files

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4. Do you have reliable transportation?*

YesNo
5. Do you have a driver's license?*

YesNo
If not, why?*
Driver's license number*
Driver's license issuing state*
Driver's license expiration date*

MonthDayYear
Date
6. Have you ever been arrested and/or convicted of a crime? Have you ever been convicted of a DUI?*

YesNo
What were the circumstances? Please explain.*
7. Have you ever been investigated or convicted of child abuse or neglect?*

YesNo
Please explain.*
8. Have you ever been investigated or convicted of sexually abusing or molesting a youth 18 or younger?*

YesNo
Please explain.*
Place of Employment *
Position *
Email*
example@example.com
Phone Number

Area CodePhone Number
Is your phone number a home or mobile number?

HomeMobileOther
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How did you hear about Waukegan to College?

Website/Social MediaSchool/TeacherFamily/FriendsChurch/Congregation/SynagogueOther
9. Why do you want to become a mentor at Waukegan to College?*
10. Do you have any previous experience volunteering or working with high school students? If so, please specify.*
11. What qualities, skills, or other attributes do you feel you have that would benefit a student? Please explain.*
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? *
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.*
6. If you had to describe yourself (select all which apply):*

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 loverfoodiehealth nuttravelermovie loverbook wormOther
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?*

15. What are your interests and favorite activities?*

	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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