Jacob's Ladder Ministries Mentorship Program Application
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Mailing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
I am applying to become a:
Mentor
Mentee
Personal Experience
Have you ever been arrested and it end in conviction?
Yes
No
Can you commit to participate in our mentoring program for one year from the time you are matched?
Yes
No
Are you available to either phone or text your mentee or mentor weekly and meet with your mentee or mentor monthly?
Yes
No
I am unsure
What kind of skills, talents or life experiences do you have that will be helpful in serving as a mentor or mentee?
This section only for prospective mentors
Prospective mentors only, complete the next three questions
Why do you want to serve as a Mentor for a person returning home from prison?
Are you willing to provide monthly information regarding your Mentorship activities to program staff?
Yes
No
Are you willing to attend an initial training session and subsequent training session to become a Mentor with our program?
Yes
No
Do you have any questions or concerns that you would like to share with us?
Agreement
Prospective mentors and mentees please complete below
In view of your commitment to enter a one-on-one mentoring partnership it is sometimes necessary to perform background checks for the protection of both mentor and mentee. Therefore do you agree to authorize Jacob's Ladder Ministries to have access to necessary information if an arrest/conviction file is found in your name?
Yes
No
Submit
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