Mentorship Registration

The LCDA's Latino Club will pair each mentee with a mentor who commits to weekly check-ins and arranges at least one in-person meeting per month. This is a volunteer position, and each student is encouraged to ask questions and gain as much knowledge from their mentor as possible. This is for the 2024-2025 school year.

Mentors are 18+ and are members of the community who have passed a background check.

What are you looking to be?*

MenteeMentor

Name*

First NameLast Name

Birth Date

MonthDayYear

Gender*

School*

Grade*

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Parent/Guardian*

Emergency Contact(s)*

Please indicate whether you'd like communications to go through the student, the parent/guardian, or no preference.

StudentParent/GuardianNo preference

Parent/Guardian: Do you agree to allow your child to communicate with a mentor*

YesNo

Student's Number*

If not preferred, please re-enter parent/guardian's number

Student Email*

example@example.com

What are your goals for this mentorship?*

Do you agree to the time commitment?*

YesNo

Why are you interested in having a mentor?*

Any preferences for a mentor?*

List gender, career field, etc.

Agreement and Consent
By submitting this form, I acknowledge and agree to the following:

Liability: I release the LCDA, its staff, and mentors from any liability related to injury, damage, or loss during the program.
Photo/Video: By submitting this form, I consent to LCDA using my photos/videos for promotional purposes. If I wish to revoke this consent, I will contact LCDA via email (lcdaclub@latinoagencyokc.org).
Code of Conduct: I agree to participate respectfully, communicate regularly, and adhere to LCDA’s behavior guidelines.
Parent/Guardian Contact: I allow LCDA to contact the parent/guardian about participation in case of emergencies.
Consent for Information Sharing: By submitting this application, I agree to allow the LCDA to share my information with my mentor, including but not limited to my name, date of birth, school/grade, address, and parent/guardian contact details.

By clicking "Submit," I confirm my agreement to all terms, and this serves as my electronic signature.

Additional Comments

Welcome to the LCDA Mentorship Program!

As a mentor, you play a crucial role in guiding and supporting our students. We ask that you check in with your mentee at least once a week via text, call, email, or another preferred method of communication. Additionally, we ask that you schedule at least one in-person meeting each month to build a strong and impactful relationship.

Your commitment is vital to this program's success and your mentee's personal growth. We appreciate your dedication to making a positive difference. To get started, please complete and submit the mentor application form.

Name*

First NameLast Name

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

Occupation/Employer*

Professional Title

If applicable

Background and interest in becoming a mentor*

Prior experience, educational background, multi-lingual, goals, etc.

Student preference*

Middle SchoolHigh SchoolUndergraduate

How many students can you commit to?*

What topic/area are you most interested in mentoring?

Can you commit to a student for the '24-'25 school year?*

YesNo

Consent to a background check?*

If you already have a recent one, please send it via email

Please provide two references*

Agreement and Consent
By submitting this application, you agree to:

Liability Release: Release the Latino Community Development Agency (LCDA), its staff, and mentors from any liability for injury, damage, or loss during the program.
Background Check: Consent to a background check. The LCDA Latino Club can assist in the process, if necessary.
Code of Conduct: Adhere to LCDA’s guidelines by maintaining respect, professionalism, and proper behavior in all interactions.
Photo/Video Consent: Allow LCDA to use your photos and/or videos for promotional purposes. If you wish to withdraw this consent, please notify LCDA via email (lcdaclub@latinoagencyokc.org).
Confidentiality: Keep all personal information about your mentee confidential and use it solely for the purpose of the mentorship program.

By clicking "Submit," you acknowledge that this serves as your electronic signature.

Additional Comments

Mentorship Registration Form