PPM VOLUNTEER APPLICATION

I hope this finds you in good health and high spirits. I express my deepest gratitude for filling out our Positive Peer Mentoring Volunteer Application. Your commitment to making a positive impact in the lives of others is truly commendable.

We understand that completing an online application can be time-consuming, and we greatly appreciate your dedication and effort in providing us with the necessary information. Your willingness to share your skills, experiences, and time with our organization demonstrates your genuine desire to contribute to the betterment of our community.

We would also like to remind you that, as stated in the application requirements, a copy of a valid government-issued photo identification, criminal background check, and child abuse record check must be attached to complete the application process. These documents are crucial in ensuring the safety and well-being of the individuals we serve, and we appreciate your cooperation in this matter.

Your commitment to fulfilling these requirements further exemplifies your dedication to the values and principles of our organization. Adhering to these protocols, you are helping us maintain a safe and secure environment for all participants involved.

Once again, we sincerely appreciate your interest in becoming a Positive Peer Mentor at Positive Peer Mentoring. Your willingness to volunteer your time and skills will undoubtedly make a significant difference in the lives of those we serve. We are truly grateful for your support and look forward to the opportunity to work together.

If you have any questions or require further information, please do not hesitate to contact us at Positive Peer Mentoring (by landline, not cell phone) at 570-202-9687 or by emailing PositivePeerMentoring@gmail.com. We are more than happy to assist you in any way we can.

Thank you once again for your dedication and commitment. We are honored to have you as part of our volunteer team.

Warmest regards,

Corinne L. Klein-Pulliam

Owner of Positive Peer Mentoring
Today's Date: *

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Personal Information:
Legal Name *

First NameLast Name
Preferred Name*

First NameLast Name
Biological Gender *

MaleFemale
What gender do you identify as?*

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Date Of Birth*

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Address*

Street Address

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E-mail Address*
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Emergency Contact
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone Number*
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How is this person related to you? (Friend, Spouse, Parent, etc.)*
Work History
Occupation*
Employer*
Employer's Address*

Street Address

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Please provide a copy of your updated resume here:

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Background Information
Highest Level of Education

1. Middle School: This option is for students attending or completing a middle school education.2. Junior High School: This option is for students attending junior high school or who have completed junior high school education.3. High School (In Progress): This option is for high school students who have not yet graduated.4. High School Diploma or Equivalent: This option is for individuals who have completed their high school education or obtained an equivalent qualification, such as a General Education Development (GED) certificate.5. Some College or Associate's Degree: This option is for individuals who have completed some college coursework or have obtained an associate's degree from a community college or similar institution.6. Bachelor's Degree: This option is for individuals who have completed a four-year undergraduate program and earned a bachelor's degree from an accredited college or university.7. Master's Degree: This option is for individuals who have completed a graduate program and obtained a master's degree.8. Doctorate or Professional Degree: This option is for individuals who have completed an advanced degree program, such as a Ph.D., M.D., J.D., or other professional degrees.Other
Why do you wish to be a volunteer at Positive Peer Mentoring?*
Special professional training, skills, and hobbies*
Please list all that are relevant.
Community affiliations (Clubs, Service Organizations, etc.): *
Please list all that are relevant.
Special Certification (CPR, Medical, etc.)*
Please list all that are relevant.
Previous volunteer experience*
Please list all forms of volunteer experince
Do you have a valid driver’s license*

YesNo
If yes to the question above, please provide your driver's license number and the state it is issued.
Please Provide a Copy of your Drivers License

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Do you have children receiving support from Positive PeerMentoring?*

YesNo
Criminal Background:
Have you ever been convicted of or pleaded guilty to any criminal offense.*

YesNo
Have you ever been convicted of or pleaded guilty to any crime(s) involving or against a minor?: *

YesNo
If you have answered to either of the above please explain.
Please Provide Pennsylvania Child Abuse History Clearance.

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Please Provide Pennsylvania State Police Criminal History Clearance.

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Please Provide Federal Bureau Of Investigatins (FBI) Criminal History Clearance

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Positive Peer Mentoring Volunteer Roles and Job Duties Description
As a Positive Peer Mentoring Volunteer, you will play a crucial role in providing guidance, support, and encouragement to individuals in need, and some people will have mental and emotional health diagnoses. Your commitment to positively impacting their lives will help them overcome challenges, build resilience, and achieve personal growth. Below is a comprehensive description of the roles and job duties associated with this volunteer position:

1. Mentorship and Support:

   - Establish a trusting and supportive relationship with mentees.

   - Act as a positive role model and provide guidance based on personal experiences.

   - Listen actively and empathetically to mentees' concerns and challenges.

   - Offer emotional support and encouragement to help mentees overcome obstacles.

2. Goal Setting and Planning:

   - Assist mentees in setting realistic and achievable goals.

   - Collaborate with mentees to develop action plans to reach their goals.

   - Provide guidance and resources to help mentees navigate their chosen paths.

   - Monitor progress and provide constructive feedback to keep mentees motivated.

3. Skill Development:

   - Identify mentees' strengths and areas for improvement.

   - Offer guidance and resources to help mentees develop new skills.

   - Provide opportunities for mentees to practice and enhance their abilities.

   - Encourage mentees to explore their interests and pursue personal growth.

4. Advocacy and Networking:

   - Advocate for mentees' needs and rights within the community.

   - Help mentees access necessary resources and support services.

   - Facilitate connections with relevant community organizations and professionals.

   - Assist mentees in building a network of supportive individuals.

5. Confidentiality and Boundaries:

   - Maintain strict confidentiality regarding mentees' personal information.

   - Respect and adhere to professional boundaries in all interactions.

   - Seek guidance from program coordinators or supervisors when faced with challenging situations.

   - Ensure the safety and well-being of mentees at all times.

6. Training and Development:

   - Attend mandatory training sessions to enhance mentoring skills and knowledge.

   - Participate in ongoing professional development opportunities.

   - Stay updated on best practices in mentoring and related fields.

   - Share insights and experiences with fellow volunteers to foster a supportive community.

In addition to the above roles, as a Positive Peer Mentoring Volunteer, you will also have the opportunity to contribute to various aspects of our program, including office administration, event coordination, and meeting participation. Your involvement in these areas will help ensure the smooth operation of our program and create a positive environment for both volunteers and participants. The specific duties associated with these additional responsibilities include:

7. Office Administration:

   - Assist with general office tasks such as filing, organizing paperwork, and data entry.

   - Help maintain a clean and organized office space.

   - Support program coordinators with administrative duties as needed.

   - Contribute to the development and improvement of administrative processes.

8. Set-Up and Clean-Up of Group Events and Sessions:

   - Assist in setting up the venue for group events and mentoring sessions.

   - Arrange chairs, tables, and any necessary materials or equipment.

   - Ensure a welcoming and comfortable environment for participants.

   - Help with post-event clean-up, including tidying up the space and returning equipment.

9. Attending Volunteer and Staff Meetings:

   - Participate in regular volunteer meetings to stay informed about program updates and changes.

   - Share insights, experiences, and suggestions during meetings.

   - Collaborate with other volunteers and staff members to address program-related issues.

   - Stay engaged and actively contribute to discussions and decision-making processes.

By fulfilling these roles and responsibilities, you will contribute to the overall success of our Positive Peer Mentoring program and make a lasting impact on the lives of those you mentor. Your dedication and commitment to this volunteer position, including office administration tasks, event set-up and clean-up, and active participation in meetings, are greatly appreciated.

Thank you again for considering this opportunity to become a Positive Peer Mentoring Volunteer.
Are there any Positive Peer Mentoring Volunteer Roles and Job Duties that you can not physically due? If yes, which ones? If you can do all Positive Peer Mentoring Volunteer Roles and Job Duties, please select number 10 ONLY.

1. Mentorship and Support2. Goal Setting and Planning3. Skill Development4. Advocacy and Networking5. Confidentiality and Boundaries6. Training and Development7. Office Administration8. Set-Up and Clean-Up of Group Events and Sessions9. Attending Volunteer and Staff Meetings10. I AM PHYSICALLY ABLE TO DO ALL OF THE ABOVE ROLES AND JOB DUTIES

What times are best for you?*

	Not Available Today	8 am-10 am	10 am-12 pm	12 pm-2 pm	2 pm-4 pm	4 pm-6 pm	6 pm-8 pm
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

REFERENCES:
Positive Peer Mentoring is a valuable program that aims to support and guide individuals in need. To ensure the effectiveness and safety of this program, it is essential to gather relevant information about potential volunteers. As part of the application process, we kindly request three references that include names, contact numbers, and addresses of individuals who can provide insights into your character, skills, and suitability for this role.

These references will be crucial in helping us assess your qualifications and determine the type of volunteer you may be. By contacting these individuals, we can better understand your attributes, work ethic, and ability to impact the lives of others through mentoring positively. Their input will assist us in making informed decisions and matching you with mentees who can benefit from your unique qualities and experiences.

Rest assured that all information provided will be treated with the utmost confidentiality and used solely to evaluate your suitability for the Positive Peer Mentoring program. We appreciate your understanding and cooperation in providing these references, as they are vital in ensuring the success and integrity of our volunteer network.

Thank you for your interest in becoming a Positive Peer Mentor and for your commitment to making a positive difference in the lives of others.
References 1: Name*

First NameLast Name
References 1: Phone Number*
Please enter a valid phone number.
References 1: Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
References 2: Name*

First NameLast Name
References 2: Phone Number*
Please enter a valid phone number.
References 2: Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
References 3: Name*

First NameLast Name
References 3: Phone Number*
Please enter a valid phone number.
References 3: Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Signatures
AS A CONDITION OF VOLUNTEERING, I permit the Positive Peer Mentoring (PPM) to conduct a background check(s) on me now and as long as I continue to be active with the organization, which may include a review of sex offender registries (some of which contain name only searches which may result in a report being generated that may or may not be me), child abuse and criminal history records. I understand that, if appointed, my position is conditional upon PPM receiving no inappropriate information on my background or with references. As a result of this release, I agree to hold harmless from liability PPM, the Owner(s), officers, employees, and volunteers thereof, or any other person or organization that may provide such information. I also understand that PPM is not obligated to appoint me to a volunteer position regardless of previous appointments.
Volunteer's Signature*

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If the volunteer is a minor, please have a parent or legal guardian sign here:

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NOTE: PPM will not discriminate against anyone based on race, creed, color, national origin, marital status, gender, sexual orientation, or disability.
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Personal Information:

Emergency Contact

Work History

Background Information

Criminal Background:

Positive Peer Mentoring Volunteer Roles and Job Duties Description

REFERENCES:

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