Senyah Mentoring Packet

WHAT IS A MENTOR?

A mentor is an experienced, trusted advisor, 21 years or older, who is willing to give of his time to help guide and assist students in achieving personal, academic and career goals. A mentor is a caring, giving member of the community who extends himself to students seeking to excel in life.

WHAT DOES A MENTOR DO?

Mentors support, listen and answer questions or help find answers, and share them with their mentee in order to aid them in making decisions that will benefit their present and future needs.

Mentors strives to make sure that their mentees are able to reach your goals. They want to make sure that in the future, their mentees spend thier time doing what makes them feel fulfilled as a person.
MENTOR PROFILE
Mentor's Name *
Home Phone *
Work Phone *
Cell phone *
Street Address *
City *
State *
Zip *
Age *
DOB *
Gender *
Ethnicity *
EXPERIENCE IN MENTORING: *
Current Employed *
Self Employed *
Branch Areas of Practice Study *
Hobbies/Interests *
Preferred times to conduct Mentor Sessions: *

During Weekday Evenings During Weekends Both Other
MENTOR QUESTIONNAIRE

The purpose of this questionnaire is to provide Senyah, Inc with a more detailed profile of you and your interests. This profile, along with your application and interview, are used by Senyah, Inc staff to best match you with a student. All elements of your profile are kept in the strictest of confidence. Thank you for taking the time to complete this questionnaire.
Name *
Education *
Other education *
WORK HISTORY (please include a brief description of responsibilities):
TITLE/DATE/DESCRIPTION *
TITLE/DATE/DESCRIPTION *
TITLE/DATE/DESCRIPTION *
Have you ever worked with young people before? If so, please describe *
If you have participated in a mentoring program before, what agency, city, state and when? *
What job skills can you share with a youth? *
What hobbies can you share with a youth? *
Can you commit to spending a minimum of 4-6 hours per month for one year with a student? *

Yes No
Do you anticipate any changes in the next year that may interfere with your ability to meet your commitment as a mentor such as marriage, childbirth, new job, moving? If yes, please explain *
Are you bilingual? If so, what languages? *
Please provide any additional information that you feel would help us match you with a youth: *
OUR MENTORING AGREEMENT
We are voluntarily entering into a mentoring relationship which we expect to benefit both of us. We want this to be a mutually rewarding experience with most of our time together spent in development activities revolving around the student's goals outlined in "Our Mentoring Plan" We note the following features of our relationship:
Frequency of Meetings:
How often will we meet? *
Day(s) of the week *
Where will we meet? *
How long will our meetings last? *
Best Time to Call/Visit:
At work *
At home *
At school *
Specific Role of the Mentor (Model, guide, observe and give feedback, recommend developmental activities, facilitate learning, suggest/provide resources, etc.)

Specific Role of the Student As willing participant in the Senyah Mentoring Program, I commit to working with my mentor throughout the program, attending all scheduled meetings with my mentor, and communicating with my mentor weekly. Emergencies happen, so if I am unable to keep a meeting date, an advance call will be made to my mentor to reschedule. I will develop personal goals and be open to coaching and feedback from my mentor.

Confidentiality Nothing that the student tells the mentor will be discussed with anyone except the Mentor Coordinator. If the mentor feels it is important to involve another adult, it will be discussed first with the student. If there is threat of physical harm to the student or to others, the mentor must break confidentiality to seek protection for the endangered individual.

No-fault Conclusion We agree to a no-fault conclusion of this relationship if, for any reason, it seems appropriate. Either party has the option of discontinuing the relationship for any reason, and he or she will discuss this decision with the Mentor Coordinator before terminating the relationship.
Mentor Signature *

Clear
Date *

Month Day Year
Date
Student Signature

Clear
Date

Month Day Year
Date
Should be Empty:

MENTOR PROFILE

WORK HISTORY (please include a brief description of responsibilities):

OUR MENTORING AGREEMENT

Frequency of Meetings:

Best Time to Call/Visit: