"ACCAPALS" Mentoring/Tutoring Program Application

"ACCAPALS" Mentoring/Tutoring Program Application

Afro-Canadian Caribbean Association Mentor Intake Package
Afro-Canadian Caribbean Association Mentor Intake Package

ACCAPALS Youth Mentorship/Tutoring Program

The "ACCAPALS" youth program aims to help Black youth in Hamilton to build a positive relationship with school and build resilience to succeed in life. It will focus on building important skills for school and future career planning, focusing on improving the core competencies (i.e. reading, wrinting, math).

The "ACCAPALS " youth program will be connecting children ages 7-16 with a tutor/mentor to engage in a minimum of 1hr weekly tutoring/mentoring sessions together.

If you have any questions or concerns, please reach out to the youth program coordinator.

Jarek Richards

Email: accayouthprogramcoordinator@gmail.com PH: 905-385-0925

Please answer the following quetions to the best of your ability.
Applicant Name*

First nameLast name
Birth date*

MonthDayYear
Date
Gender*
Email*
example@example.com
Phone Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mentoring/Tutoring Preferences & Availability
What age group(s) are you interested in working with?*

Elementary 8-12 years oldMiddle School 13-15 years oldHigh-School 16-18 years old
What days of the week are most suitable for you to meet with your mentee?*
What time of day is most suitable for you to meet with your mentee?*
Mentee Background Information
Do you speak any other languages other than English? If yes, please list
Please list any special interests that you have*
Why do you want to become a mentor?*
Do you have any previous experience volunteering with youth?*
Can you commit to meeting (in person or online) your mentee at least once per week?*

YesNo
Can you commit to participate in ACCA Mentoring/Tutoring program for a minimum of 1 year? (i.e. 2024-2025 School year)*

YesNo
Employment and Education History
Education/Employment History

*Please provide employment history for the last 5 years, with most recent position held first, and your educational educational history with your most recent educational institution?
Educational Institution*
School Name
Area of Study*
Program
From - To*
YYYY-YYYY
Educational Institution Address*

School Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Employer Name*
Position Held*
Address Information*

Employer Address

Street Address Line 2

CityState / Province

Postal / Zip Code
ACCA Notice Agreement

Please read and sign below

By choosing to participate in the Afro Canadian Caribbean Association Mentoring program, I agree to:
- Follow all rules and guidelines as outlined by the program coordinator, mentor training, program policies, and this contract.
- Be flexible and provide the necessary support and advice to help my mentee succeed. Make a one-year commitment to being matched with my mentee.
- Obtain parent/guardian permission for all 1on1 meetings at least 24-48 hours in advance.
- Be on time for scheduled meetings or call my mentee at least 24 hours beforehand if I am unable to make a meeting.
- Submit monthly meeting times and activities to the Program Coordinator, and regularly and openly communicate with the Program Coordinator as requested
- Keep any information that my mentee tells me confidential except as may cause him/her or others harm.
- Always to obey traffic laws when in the company of my mentee and always keep a copy of his/her health card in the automobile when traveling together.
- Never be in the presence of my mentee when I have or am consuming alcohol, tobacco, or controlled substances. Participate in a closure process when that time comes.
- Attend in-service mentor training sessions monthly/ as needed
(please initial) I understand that upon match closure, future contact with my mentee is beyond the scope of the "ACCAPALS" mentoring/tutoring program and may happen only by the mutual consensus of the mentor, the mentee, and parent/guardian.*
I, agree to follow all the above regulations of this program as well as any other conditions as instructed by the Program Coordinator at this time or in the future.*

Clear
Should be Empty:

"ACCAPALS" Mentoring/Tutoring Program Application

Mentoring/Tutoring Preferences & Availability

Mentee Background Information

Employment and Education History