Mentor/Coach Application Form

Mentor/Coach Application Form

Empowering Youth for Life, Leadership, and Community
Purpose: This form collects information from individuals interested in mentoring or coaching youth through Next Path Alliance. Our mentors and coaches play a vital role in guiding young individuals toward success in leadership, career readiness, and personal development.

Please complete the form in full.
Personal Information
Full Name:

First NameLast Name
Date of Birth:

MonthDayYear
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number:
E-mail Address:
example@example.com
Preferred Contact Method:

PhoneEmailText
T-Shirt Size:

Adult SAdult MAdult L
Emergency Contact
Name:

First NameLast Name
Relationship:
Phone Number:
Please enter a valid phone number.
Mentorship/Coaching Interest: (Check all that apply)

One-on-One MentoringGroup MentoringCareer & College ReadinessLeadership DevelopmentLife Skills & Personal GrowthSports CoachingEntrepreneurship & Innovation
Other:
Availability:

WeekdaysWeekendsMorningsAfternoonsEvenings
Specific Days:
Professional & Educational Background
Current Employer (if applicable):
Job Title:
Educational Background:
Relevant Experience: (Education, previous volunteer work, certifications, etc.)
Experience & Skills
Have you previously mentored or coached youth?

YesNo
If yes, please describe your experience:
Special Skills & Areas of Expertise (Checkall that apply):

Public SpeakingConflict ResolutionCareer GuidanceCollege PrepMental Health & WellnessFinancial LiteracyEntrepreneurshipSports & FitnessSTEM Education
Other:
Background Information
Have you ever been convicted of a crime?

YesNo
If yes, please explain:
Do you consent to a background check?

YesNo
References

(Provide two professional or personal references)
1. Name:

First NameLast Name
Relationship:
Phone Number:
Please enter a valid phone number.
Email Address:
example@example.com
2. Name:

First NameLast Name
Relationship:
Phone Number:
Please enter a valid phone number.
Email Address:
example@example.com
Agreement & Signature:

By signing below, I affirm that the information provided is accurate. I understand that completing this form does not guarantee a mentorship/coaching position and that a background check may be required. I agree to uphold the values and mission of Next Path Alliance.
Printed Name:
Signature

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Date

MonthDayYear
Date
Thank you for your interest in becoming a mentor or coach with Next Path Alliance! We will review your application and contact you shortly.
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Mentor/Coach Application Form

Purpose: This form collects information from individuals interested in mentoring or coaching youth through Next Path Alliance. Our mentors and coaches play a vital role in guiding young individuals toward success in leadership, career readiness, and personal development.

Personal Information

Emergency Contact

Professional & Educational Background

Experience & Skills

Background Information

References

Agreement & Signature:

Thank you for your interest in becoming a mentor or coach with Next Path Alliance! We will review your application and contact you shortly.