Planet Gyrl
Mentor Application
planetgyrl@gmail.com
IG: _planetgyrl
New mentor application Form
We appreciate your interest in becoming a mentor. The information in this application will help us to match you with a mentee(s) and will be kept confidential.
Full Name
*
First Name
Last Name
DOB
*
Date of Birth
Age
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
E-mail
example@example.com
How did you hear about Planet Gyrl?
*
Please Select
Instagram
Facebook
Friend
Other
Please Specify
*
Do you have a valid Driver's License/ID?
Yes
No
Would you agree to have us run your name for a background check?
Yes
No
Work Details
Occupation
Employer Name
Education History
*
University Name
Graduation Date (Please write current if you are currently enrolled)
PLEASE LIST A FEW WORDS THAT DESCRIBE YOUR PERSONALITY (EG. SENSITIVE, QUIET, OUTGOING) :
*
List two people who can serve as a character reference for you.
Full Name
Relationship
Contact Number
1
2
Back
Next
If you agree to become a mentor, you will be asked to agree to the following basic requirements:
..To attend a Mentor Orientation and Training before you are matched with a group. ..To attempt to meet at least once a month for 7 months and to notify a leader in advance if you are unable to attend a meeting. ..To be dedicated and dependable in trying to assist your mentees to achieve success in their educational and emotional development. ..To base your relationship on respect for the teen and their family. Planet Gyrl reserves the right to accept or decline volunteers based on the information gathered. For reasons of confidentiality Planet Gyrl will not share this information or reasons of denial with any applicant. I certify that the information I have supplied is correct to the best of my knowledge. I give my permission to complete a background check.
Signature
*
Electronic Signature
Date
Submit
Should be Empty: