CHAMPS Rolling Mentor Application
This is a rolling application for the CHAMPS Mentorship Program. We meet once a week on Monday evenings from 5:30-8:00 PM and connect UoR student volunteers with local High School students to build positive bonds with mutual growth for mentors and mentees. The goal of this program is to show local high schoolers what it's like to be a UoR student.
Name
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First Name
Last Name
Email
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example@example.com
Student ID Number
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Year in School
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GPA (current or most recent)
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Please list major, minor, emphasis, or undeclared
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T Shirt Size (adult size)
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XS
S
M
L
XL
XXL
Please list the languages you speak and whether you have basic, conversational, or fluent speaking abilities.
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Why do you want to volunteer with CHAMPS?
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Do you have any plans to study abroad? If so, when?
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Criminal History
All volunteer positions require a Criminal History check. Conviction will not necessarily disqualify you from participating.
Have you ever been convicted of a felony? If yes, please explain.
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All volunteer positions working with minors are required to complete and serve as a mandated reporter. A mandated reporter is required by law to report known or suspected abuse or neglect relating to children. Please sign to indicate you understand and agree that you will receive training and be obligated to follow the University's policy on minors and mandated reporting.
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The Office of Community Service Learning considers applications for internships/volunteering without regard to sex, race, age, religion, national origin, veteran or marital status, or any other legally protected status. We provide reasonable accommodation to qualified individuals with disabilities when it would not be an undue hardship. If you need a reasonable accommodation in the pre-placement process, please contact the Associate Director.
Authorization and Agreement by Applicant
By signing this document I agree that, 1. I certify that the facts set for in this volunteer application are true and complete to the best of my knowledge. I understand that any false statement, omission or misrepresentation in my application or placement interview may result in the rejection of my application or discharge from the volunteer program. 2. I consent to having the Office of Community Service Learning complete a criminal background check and a student conduct review prior to volunteering.
Signature
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Submit
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