INSPIRE MENTOR APPLICATION
Thank you for your interest in serving as a volunteer with the CCOC INSPIRE Mentor program through Clayton Middle School.
Name
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First Name
Last Name
Gender
Birth date
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Please list any previous mentorship (or other related) experience:
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Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Cell Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Employer
*
Job title
*
Work Phone
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Can you be contacted at work? If so, what are you work hours?
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What motivated you to participate in the CCOC INSPIRE Mentoring Program coordinated by CCOC's Education Committee?
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Can you meet with the child once a week (30 mins) during the school year?
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What do you like to do in your leisure time?
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To what service or social groups do you belong?
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Have you ever been convicted of a crime? (if yes, explain) We will follow up with information on background check and JCPS Level 2 Volunteer Application.
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Please list three references (full name, mailing address, phone number, email address, and relationship) who have known you for more than one year. By listing these names you authorize us to contact them in order to evaluate your qualifications as a volunteer. Do not include more than one family member.
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Where/how did you hear about becoming an INSPIRE mentor?
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Submit
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