Mentor/Volunteer Application
Complete this intake form if you are interested in applying to be a mentor or volunteer for the organization.
Do you have a child(ren) that is currently enrolled in other S.H.I.F.T.I.N.G Paths programs? If so, please provide their name.
*
Yes
No
Child #1 Full Name
First Name
Last Name
Child #2 Full Name
First Name
Last Name
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Personal Information
Full Name
*
First Name
Last Name
Birthdate
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Age
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
What is your email address?
*
Sex
*
Male
Female
Race
*
Black or African American
White
Native American or Alaska Native
Asian
Native Hawaiian, Samoan, or other Pacific Islander
Other
I prefer not to provide this information.
Ethnicity
*
Hispanic or Latino
Not Hispanic or Latino
I prefer not to provide this information.
Are you willing to submit to a background check?
*
Yes
No
Do you possess a valid driver's license?
*
Yes
No
Attach a copy of your valid driver's license.
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Have you ever been arrested?
*
Yes
No
Have you ever been convicted of a felony?
*
Yes
No
If yes, please explain?
Do you have any open criminal cases against you?
*
Yes
No
If yes, please explain?
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Background & Motivation
How did you hear about S.H.I.F.T.I.N.G Paths, Incorporated?
I am interested in being a
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Mentor
Volunteer
Both
Why would you like to become a part of S.H.I.F.T.I.N.G Paths, Incorporated?
*
What are some skills that you possess that will make you an ideal mentor or volunteer?
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What would be the best advice you would share with the youth that we are servicing?
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How many years of experience do you have working with children?
*
Have you had any previous mentoring, tutoring, or youth-work experience? If yes, please explain.
*
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Employment
Please provide information for your current employer.
What is your occupation?
*
Employer
*
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Supervisor
*
Personal References
Three (3) personal, verifiable references is required.
Name
*
First Name
Last Name
Relationship
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Name
*
First Name
Last Name
Relationship
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Name
*
First Name
Last Name
Relationship
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
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Mentorship Availability
This section is to gauge your availability to commit to the organization and your mentor.
What days are you available? Check all that apply
*
Weekdays (Monday - Friday)
Weekends (Saturday - Sunday)
Evenings (After 5PM)
Virtual Meetings (Zoom / Microsoft Teams)
In-Person Meetings
Weekly Check-ins
How many hours per month can you commit to the youth mentoring relationship?
*
1-2 hours per month (About 15-30 minutes per week) (Example-Roughly 1 short call or meeting every other week)
3-5 hours per month (About 45 minutes- 1.25hours per week)
6-8 hours per month (About 1.5- 2 hours perweek)
9-12 hours per month (About 2.25-3 hours perweek)
13+ hours per month (About 3+ hours per week)
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*
Signature
*
Upload a current photo that is clear.
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