MomTor Questionnaire
Todays Date
-
Month
-
Day
Year
Date
Name
*
First Name
Last Name
Age
*
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Which Position are you interested in?
*
Momtor I
Momtor II (Bilingual/Spanish)
Volunteer/Other Role
Check the Clearances you have. (Clearances need to be within last two years)
*
Child Abuse (State)
Criminal History
FBI Fingerprints
How would you prefer to communicate with your mentee?
*
Email
Phone
Face to Face (Recommended)
Virtual
What would you like to get out of mentoring?
*
What motivates you? And what are you passionate about
*
Why do you want to mentor young mothers? And why is that important to you?
*
If matched how will you seek support for your mentor/mentee relationship?
*
How do you feel about possible ethnic, religious, and/or racial differences between you and the student you could be matched with?
*
What expectations do you have about the relationship you may have with your mentee?
*
Did you ever have a mentor and do you have any mentors in your life right now?
*
How open are you to sharing your personal values and learning about the differences in values of your mentee?
*
Can you commit to meeting with your mentee twice a month? Can you keep communication with your mentee weekly?
*
Explain your availability.
*
Would you like to ask me anything about the Melanin Mommies Pgh, Inc.?
*
Submit
Should be Empty: