Tutor Application

Mentor Application

Youth Connective is a one-month summer peer mentorship program designed for rising 10th and 11th graders. With 8 sessions, this paid $15 an hour summer position begins on July 11th and concludes on August 14th. As a participant, you will have an incredible opportunity to mentor middle schoolers and make a positive impact in their lives. Youth Connective is run by the Dedham Organization for Substance Awareness (DOSA) a community coalition that promotes awareness and healthy decision making with the goal of preventing youth substance misuse. Join Youth Connective and contribute to a healthier and more empowered community!
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Format: (000) 000-0000.
Gender
E-mail Address*
Grade Level*
Do you have the ability to work 8 sessions that occur from July 11th to August 14th on Tuesday and Thursdays from 12:30- 3:30pm?
Do you have any mandatory summer obligations?
Please tell us a little about yourself:
We aim to provide a great match between the Mentor and the Mentee. This enhances the experience and adds real value to the Mentee and the Mentor. To help us make this match give us some idea of your interests, hobbies, etc.
YesNo
If yes, please state which extracurriculars
YesNo
Do you have access to a vehicle?
YesNo
Please tell us of any special skills you may have.
YesNo
YesNo
Do you have any allergies we should be made aware of?
Is there anything else you'd like to share or have us be made aware of?
Please provide the names of two professionalor a personal references.
First Reference
Name*
Profession/Relationship*
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Second Reference
Name*
Profession/Relationship*
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
please put your Emergency Contact information below *

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Should be Empty:

Mentor Application