NYC Salt Mentor Application Form

MENTOR APPLICATION FORM

Thank you for your interest in serving NYC Salt. Your time and service to us is extremely valuable. Please fill out these questions so that we can process your application.
A. Personal Information
Today's Date*

MonthDayYear
Name*

First NameLast Name
Preferred Email*
example@example.com
Preferred Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Name of employer (company)*
Job Title*
Address of employer*

Street Address

Street Address Line 2

CityState

Zip Code
Tell us why you would like to mentor.
How did you find us?
Did you go to college? (We ask so we have a record of alumni for our students to refer to as they choose where they want to go.)*

YesNo
If so, What College, University did you attend?
What was your degree and major?
Do you have a master's degree or other professional trade training?

YesNo
What Institution did you go to receive your master's degree or other professional training?
What is your degree in?
B. Volunteer Information
1. It is expected that at least 1 hour each week be set aside for interaction specific to the mentoring relationship (according to the position description), and meeting with the student in person for editing. Will it be possible for you to provide the expected time?*

YesNo
2. Within the past 10 years, have you been convicted of any felony or misdemeanor classified as an offense against a person or family, or an offense of public indecency or a violation involving a stat/federally controlled substance?*

YesNo
3. Are you under current indictment or has a district/county attorney accepted an official complaint for any of the offenses in question #2?*

YesNo
If the answer is YES to question 3, please explain below:
C. References
Please provide the information for two personal references.
Reference 1*

First NameLast Name
Phone Number*

Area CodePhone Number
Email*
example@example.com
Relationship*
Reference 2*

First NameLast Name
Phone Number*

Area CodePhone Number
Email*
example@example.com
Relationship*
D. Additional Information
Examples of your Work

We would like to see examples of your work. Please provide a professional Instagram Handle and/or website if you have one.
Instagram
Your Website
Company Website
Please upload your resume:
Please attach most updated resume or bio

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In making this application to be a volunteer, I understand that the NYC Salt routinely performs criminal and driving record checks on all volunteers. By signing below, I agree this check be performed. If I fail to sign, it may be grounds for rejecting me as a volunteer. Furthermore, I certify to the best of my ability that the information provided on this application is true and accurate. I also understand that misinformation knowingly provided here, and on subsequent volunteer forms, is grounds for dismissal.
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MENTOR APPLICATION FORM

A. Personal Information

C. References

D. Additional Information