Title/Position Applying For
Name of Applicant
First Name
Last Name
Highest Educational Attainment
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Have you already had a one-to-one meeting with the Program Director: Mrs. Gwen
Please Select
Yes
No
If NO, you will be contacted to schedule a virtual interview within 24-48 hours of our office receiving your application. *****If YES after your application has been received and reviewed you will be contacted to schedule your Level2 background check.
Civil Status
Single
Married
Divorced
Widowed
Age Requirement- Must be at least 25 years of age.
Please Select
Yes
No
Are you 25 years of age or older?
Parenting Experience -Do You Have Children?
Please Select
Yes
No
Please provide the age of your children if any?
Do you understand that you will need to submit to, and pass a Level 2 background check before being placed with a mentee match?
Please Select
Yes
No
Mandatory Level 2 Background Check
Do you have reliable transportation?
Please Select
Yes
No
Trasnportation is required.
Have you ever mentored with any other programs before?
Please Select
Yes
No
Do you agree to participate in an initial mandatory 1-day mentor training prior to being matched?
Please Select
Yes
No
Do you agree to participate in an initial mandatory 1-day mentor training prior to being matched with a mentee and any continuous mentor education trainings provided? ****The 1-day mentor training is held at Indian River State College on a Saturday from 9am -5pm. ******
Do you agree to participate in an initial mandatory 1-day mentor training prior to being matched?
Please Select
Yes
No
Do you agree to participate in an initial mandatory 1-day mentor training prior to being matched with a mentee and any continuous mentor education trainings provided? ****The 1-day mentor training is held at Indian River State College on a Saturday from 9am -5pm. ******
Type a question
Please Select
Mentor Participation Accountability Commitment
Please Select
Yes
No
Can you commit to working with a mentee for 2-4 hours per week by: (1) being available to attend a 2 hour support group mentoring meeting one night a week with your mentee from 6pm - 8pm, for at least one year? (2) Being available to connect with your mentee for at least 2 documented hours per week outside of group time?*** We need dependable people for this assignment if you have any doubt that you can't be consistent, please reconsider applying for this position.
Mentee Age Group Preference
Please Select
Age 13-17 years of Age
Age 17-24 years of Age
No Preference
Please select the age group of mentees you would prefer to work with .
Number Of Mentees Option
Please Select
I prefer to assist only 1 Mentee
I can assist 2 Mentees
I can assist 3 Mentees
Can you be a mentor for more than one mentee at the same time?
This Mommy Mentoring Academy is a Beta Pilot Launch and mentors will be helping us to collect data to improve the program throughout it's first year. The WE LEAP Mommy Mentor Academy is the first program of its kind in St. Lucie County. Please tell us what skillset you bring to the organization, why you want to be a mentor and why you believe that mentoring first time pregnant teens and young adults is important. ***Do not skip this section.*** (Please leave a comment here)
Here is your time to shine, and share!
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