Mentor Application

Mentor Application
If you love children and are passionate about building relationships, we want to connect you with a child who is waiting for a mentor like you!

Mentors help children reach their God-given potential by offering them another godly example, wisdom, friendship, and most importantly, unconditional love. We are so excited that you are considering investing in the life of a child in this incredible way!

Once your application is complete a Mentor Coordinator will review it and contact you with your next steps.
Region*
Program Interest
General Information
Name*

First NameLast Name
Gender*
Ethnicity*
Date of Birth*

MonthDayYear
Date
Marital Status*
Primary Religion*
What church do you currently attend?*
Are you a military veteran?*
If you are currently employed, then please list the name of your employer
Contact Information
Email Address*
example@example.com
Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Country
Mobile Telephone Number*
Please enter a valid phone number.
Other Phone Number
Please enter a valid phone number.
Preferred Communication Method*

Cell PhoneHome PhoneTextSocial MediaEmailOther
Preferred Time of Day for Communication*
Preferred Language*
Tell us some things that you enjoy doing!

Check all boxes that apply
1.

Arts/Crafts
2.

Board Games
3.

Community Service/Volunteerism
4.

Computer/video games
5.

Cooking/Food
6.

Cultural events
7.

Dance
8.

Drama
9.

Fashion
10.

Movies
11.

Music
12.

Outdoor Activities
13.

Pets
14.

Reading
15.

Shopping
16.

Sports
17.

Sports: Playing Sports
18.

Travel
19.

TV
20.

Writing
Other Interest(s)
Arts/Crafts

Arts/Crafts
Board Games

Board Games
Community Service/Volunteerism

Community Service/Volunteerism
Computer/video games

Computer/video games
Cooking/Food

Cooking/Food
Cultural events

Cultural events
Dance

Dance
Drama

Drama
Fashion

Fashion
Movies

Movies
Music

Music
Outdoor Activities

Outdoor Activities
Pets

Pets
Reading

Reading
Shopping

Shopping
Sports

Sports
Sports: Playing Sports

Sports: Playing Sports
Travel

Travel
TV

TV
Writing

Writing
Please let us know how you heard about our program:*
If you said other, please specify.
I give permission for Mentoring Alliance to take photos and/or videos of me. I understand that said media may be used alongside my first name for advertising, marketing, or other communication purposes. I reserve no right to any royalties or fees from said media.*
Should be Empty:

Mentor Application

General Information

Contact Information

Tell us some things that you enjoy doing!