AAMA Mentoring Application

Today’s Date*

MonthDayYear
Date
HOPE UNITED COMMUNITY DEVELOPMENT CORPORATION AFRICAN AMERICAN MALE ALLIANCE MENTORING PROGRAM
Mentor Application
PERSONAL INFORMATION
Name*

First NameLast Name
MI
Present Address*

Street Address Line 2

CityState

Zip Code
E-mail*
example@example.com
Would you like to be added to the Hope United CDC mailing?*

YesNo
Phone Number
Home
Please enter a valid phone number.
Cell
Please enter a valid phone number.
Days and Times Available*
Why do you want to volunteer here?*
Do you speak a language other than English?
Please list any special interests, skills or experiences?*
Employment Information

	Employer	Position	Phone Number
Current
Previous

Driving Information

(if applying for a position that requires driving during the program)

	Name	Address	Phone	Relationship/Yrs Acquainted

	Organization	Location	Position

	Name	Address	Phone

CRIMINAL BACKGROUND
Have you ever been convicted of a crime? If yes, please explain the charges:*
I submit the statements on this application as true, complete, and correct to my best knowledge.

I authorize that the references listed above can be contacted to provide information concerning my previous employment, volunteer experience, and educational history and any pertinent information they may have and release all parties from all liabilities for any damage that may result from that.

I give the Hope United CDC permission to take pictures of me performing volunteer services at Hope United and to use the pictures for promotional and informational purposes through a variety of communication venues.
Signature*

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Mentor Application