Mentorship application for straight talk for teen girls

Thank you for taking interest in mentoring for Straight Talk 4 Teen Girls. Our mission is to help young ladies learn to take responsibility for their feelings, thoughts, choices, and develop a positive self-image.

Please complete this application to determine if you are a good fit for Straight Talk 4 Teen girls and we will reach out to you for the next step.

Thank you for your time & consideration!

Name

First NameLast Name

Preferred Pronouns

Phone Number

Email

example@example.com

Have you ever been in jail or imprisoned?

YesNo

Are you currently on probation? If so please briefly explain it below

Preferred method of communication

EmailTextingPhone Calls

Which age group do you prefer?

9-1112-17No preference

What is your highest level of completed education?

If you attended College, where did you attend and what was your major?

Employer:

Description of duties

What is your position?

Do you have any experience in mentoring the youth?

Why are you interested in mentoring with Straight Talk 4Teen Girls?

What are some of your strengths and weaknesses?

Are you able to commit to an 6 week program? (2 in person meetings a month)

YesNo

Would you be willing to go through a background check?

Are you willing to attend a training session before you become a mentor?

References Name

First NameLast Name

References Email

example@example.com

References Phone Number

Relationship to you:

References Name

First NameLast Name

References Email

example@example.com

References Phone Number

Relationship to you:

I certify that the information contained in this application is complete and truthful.

YesNo

I understand that if I am accepted into the Straight Talk Mentoring Program, I will be expected to attend trainings and workshops when needed.

YesNo

I understand that the Straight Talk Mentoring Program is not obligated to provide a reason for their decision in accepting or denying my application to become a mentor.

YesNo

I understand it will be necessary for Straight Talk to conduct a background check regarding my criminal history, personal references, and employment. I authorize Straight Talk to obtain any needed information regarding my legal/criminal history, character references, and employment from any state or federal agency, my employer, and personal references for the purposes of participating in the mentoring program.

YesNo

I understand that information about myself may be anonymously shared with a prospective mentee and their parent(s)/guardian(s) to aid in determining a suitable match. Once a mentor/mentee match is determined, my identity and any other information known about me may be shared with the mentee and parent/guardian to aid in facilitating a safe and successful match relationship.

YesNo

COVID - 19 Release I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the CDC and many other public health authorities still recommend practicing social distancing. I further acknowledge that ABDTYIP has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19.I further acknowledge that ABDTYIP can not guarantee that I will not become infected with the Coronavirus/Covid-19. I understand that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to, staff, and other clients and their families. I hereby release and agree to hold ABDTYIP harmless from, and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself15and/or property that may be caused by any act, or failure to act of the salon, or that may otherwise arise in any way in connection with any services received from ABDTYIP. I understand that this release discharges ABDTYIP from any liability or claim that I, my heirs, or any personal representatives may have against the salon with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any services received from ABDTYIP. This liability waiver and release extends to the salon together with all owners, partners, and employees.

AgreeDisagree

I agree to allow the Straight Talk Mentoring Program to use any photographic image of me taken while participating in the mentoring program in Straight Talk marketing and recruitment materials. (this is optional)

YesNo

Signature

Date of Signature

Date

If you have any questions about your application or the program please contact:

A Better Day Than Yesterday Inititave Program

info@abetterdaythanyesterday.org

OR

call (804) 299-1932

Visit our Website

https://www.abetterdaythanyesterday.org

Education

Employment

Application Questions

References

Terms of Agreement