N2Life_MentorApplication

N2Life Project Mentor Application
You must be at least 25 years of age to mentor. Are you at least 25 years old?*

Yes, I am 25 or older.
Please continue applying by completing the sections below.

Mentoring Commitment
Earliest Date You Can Start

MonthDayYear
Will you commit at least one hour each week or two hours every other week to your mentee?

Yes
If you cannot commit to the schedule above, please explain:
Mentoring Partner. Kansas Department of Corrections requires female mentors to pair with a male mentor.

Find a mentoring partner for meI have a mentoring partner
Mentoring Partner's Name

Faith Community
Name of Faith Community
Faith Community Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Faith Community Phone Number

Area CodePhone Number
Faith Community Leader

First NameLast Name
Leader's Title
Does your faith community have a prison ministry?

Yes
Name of Prison Ministry
Name of your faith community's prison ministry

Employment Information
Employment Status

EmployedRetiredNot Employed
Please state your current or most recent employer:
Current or Most Recent Employer*
Employed From Date*

MonthDayYear
Employed To Date*

MonthDayYear

Training and Skills
Hobbies, passions, and special skills that might help us match you with an incarcerated client:
I have religious or ministry training.

Yes
I have completed the required Kansas Department of Corrections Mentoring 4 Success training.

Yes
Have you been incarcerated in the past?*

YesNo

Incarceration History
Please list recent institutions and years at each institution.

Incarceration history will NOT automatically disqualify you.
Institution Name
From Year
To Year
Institution Name
From Year
To Year
Institution Name
From Year
To Year
Are you currently on probation or parole?

Yes
Officer's Name
When will supervision end?

Authorize and Submit
References

I am willing to provide references on request
By clicking the submit button, I certify that the facts contained in this application are true and complete to the best of my knowledge.*

I agree
Electronic Signature*

First NameLast Name
Please type the words you see below.*
Newsletter

Yes, subscribe me to the N2Life Project newsletter.
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