Mentor Application
We ask that our mentors commit to their mentee for the full length that he/she is in the program, up to two years. The monthly expectations of mentors are to connect with their mentee for a total of six hours a month. The time commitment encompasses the twice a month ‘Mentor Nights” as well as other calls/texts throughout the month. We want our mentors to establish trust, maintain confidentiality, and provide guidance and encouragement, as well as share personal experiences and perspectives with their mentees. Our hope is that our mentors are with our young adults for life. The goal would be that your mentee would be invited in to be a part of your family life: that these relationships remain a support system to them long after their time here.
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Personal Information
Date of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Male
Female
Marital Status
*
Please Select
Single
Married
Widowed
Divorced
Spouse's Name
*
First Name
Last Name
Do you have children?
*
Yes
No
How many children do you have and what are the ages?
*
How does your family feel about your involvement in mentoring?
*
Employment Status
*
Employed Full-Time
Employed Part-Time
Self-Employed
Unemployed (seeking employment)
Unemployed (not seeking employment)
Current Occupation
*
Please list any post secondary degrees, earned, or in progress, and the institutions attended.
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Mentoring Section
Mentoring a young person is a big responsibility and can change the lives of both the mentor and the mentee. What do you hope to gain from the experience?
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Have you ever mentored before? If so, what program/connection was it through?
*
Do you have any hobbies, interests, or special skills that you think will benefit our mentees? Please describe those below.
*
What do you hope the mentee will gain?
*
What resources or support will you be able to provide your mentee?
*
Do you see yourself inviting your mentee in your life (holidays, dinners, church, etc.)? Explain.
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Please describe what faith means to you and how it is incorporated into your life.
*
Do you currently attend church?
*
Yes
No
Where do you attend?
*
Do you feel like you have enough time and space to give at least six hours a month to mentoring?
*
Yes
No
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Character References
Reference #1
Name of Reference
*
First Name
Last Name
Relationship to Reference
*
Duration of Relationship
*
Phone Number for Reference
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email for Reference
*
example@example.com
Reference #2
Name of Reference
*
First Name
Last Name
Relationship to Reference
*
Duration of Relationship
*
Phone Number for Reference
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email for Reference
*
example@example.com
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Safety
Have you ever been a subject in an investigation in this or any other state for sexual abuse or harassment?
*
Yes
No
Have you ever been a subject in an investigation in this or any other state for possession, use or distribution of illegal or prescription drugs?
*
Yes
No
Have you ever received or been treated for a mental health diagnosis?
*
Yes
No
Have you experienced any past abuse (physical, sexual, emotional)?
*
Yes
No
If yes, have you sought help?
*
Submit
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