Operation Timothy Orientation / Mentoring Application

Operation Timothy Orientation / Mentoring Application

Operation Timothy Mentoring Program is accepting new boys into its program! A Parent Orientation Meeting will be held on Sunday, September 28th from 10 AM to 11 AM. Parents / Guardians who are interested in having their sons, nephews, or other boys in their lives to participate in Operation Timothy should attend this orientation. The program equips boys, ages 11 to 18 years old, to be productive in their personal life, community life, and work life with the assistance of positive role models. ** Operation Timothy is open to the public — help spread the word by telling your friends and family about it. ** Men who are interested in becoming mentors are invited to attend as well. **NOTE: Operation Timothy Boys Mentoring Program is a program administered by Liberty Community Development Corp (www.lcdcorp.og).
ORIENTATION LOCATION:

The O.W.E. Center - 2nd Flr (The Lounge in the Youth Wing)

6901 Security Blvd, Baltimore, MD 21244
YOUTH / TEEN INFO
Youth's Name*

First NameLast Name
Youth's email*
Youth's Cell Number*
Please enter your best contact number
Birthdate (MM/DD)*
example: Enter June 24 as 06/24
Youth's Age*
Select current age
Name of School Youth Attends*
Current Grade*
Select current grade as or Sept. 2025
PARENT INFO
Parent / Guardian Name*

First NameLast Name
Relationship to Youth*
Please select one
Parent / Guardian Email*
Parent / Guardian Cell Number*
Please enter your best contact number
Address*

Street Address

Street Address Line 2 (enter Apt / Unit #)

CityState / Province

Postal / Zip Code
** EMERGENCY CONTACT & PHONE NUMBER*
i.e. Joan Smith, 443-444-1212
APPLICATION QUESTIONS

Please answer all of the following questions as completely as possible. The answers to these questions will aid us in the mentor matching process.
1. Why do you/your child want to participate in a mentoring program? *
2. Is your child available to meet with a mentor a minimum of one hour per week via phone, text, FaceTIme or by email?*
3. Is your child available to meet in-person from 10:00 AM - 11:30 AM for our sessions on the 2nd Sunday of each month? *
4. Is your child available to participate in community outreach activities and scheduled trips?*
5. Please explain any particular scheduling issues that you may have, if applicable.
By submitting this form, you agree to the following:
- I give my informed consent and permission for my child to participate in the Operation Timothy Mentoring Program and its related activities.
- I agree to have my child follow all of the mentoring program guidelines and understand that any violation on my child’s part may result in suspension and/or termination of the mentoring relationship.
Parent's Signature*

Clear
Place your cursor in the box & use your mouse to provide a digital signature
Should be Empty:

Operation Timothy Orientation / Mentoring Application

YOUTH / TEEN INFO

PARENT INFO

APPLICATION QUESTIONS