TEAK Mentor Application
Thank you for your interest in becoming a TEAK Mentor!
Full Name
*
First Name
Last Name
Personal E-mail
*
ex: teak@example.com
Cell Phone Number
*
Please enter a phone number where we may contact you.
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Company
*
Work Title
*
Work Email
*
example@example.com
How did you hear about TEAK/the Mentor Program?
*
Background Questions
Please answer the following questions so we can learn more about your background for the matching process.
What is your gender?
*
Man
Woman
Non-binary/Non-conforming
What is your cultural/ethnic background?
*
African-American
Asian-American
Latinx
White American
European
Asian
African
Multi-ethnic
Native American
Other
What type of high school did you attend?
*
Public
Private
Parochial
Day
Boarding
Co-Ed
All Girls
All Boys
Other
High School Attended
*
College Attended
*
College Major
*
Did You Attend Graduate School or Further Education?
*
Yes
No
List all additional post-college schooling
Can you speak any languages other than English?
*
Yes
No
What other languages can you speak?
Mentor Program Questions
Please answer the following questions so we can learn more about your availability to commit to the Mentor Program and your interest in participating.
Are you able to make a two-year commitment working with your mentee throughout their middle school years?
*
Yes
No
Please describe any issues or circumstances that might affect your commitment.
Are you able to commit to meet with your Mentee at least 12 times a year and email or phone twice a month as required by the TEAK Mentor guidelines?
*
Yes
No
Please describe any issues or circumstances that might affect your commitment.
TEAK organizes at least 6 mentor/mentee events annually, mostly taking place on Saturdays. Are you able to commit to attending at least 3 of these organized events?
*
Yes
No
Please describe any issues or circumstances that might affect your commitment.
Why do you want to be a TEAK Mentor?
*
Mentoring a young person is a big responsibility and can change the lives of both the Mentor and the Mentee. What do you hope to gain from the experience? What do you hope your Mentee will gain?
*
Have you ever been a Mentor before?
*
Yes
No
Please briefly describe your experience.
Have you ever been convicted of a misdemeanor or felony?
*
Yes
No
Please explain.
Is there anything else about yourself you would like to share with TEAK?
Submit
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