Mentor Application

Mentor Application

Thank you for your interest in investing in a mentoring relationship. Our hope is that mentors and mentees become true friends, growing alongside each other. Thank you for thoughtfully filling out this application so we can pair you with a mentee who shares similar life experiences or interests.
Full Name*

First NameLast Name
Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Email Address*
Phone Number*

Area CodePhone Number
Please list the names, ages, and relationship types of everyone in your household.
Please list three references and their phone numbers
Reference #1*

First NameLast Name
Phone Number*

Area CodePhone Number
Reference #2*

First NameLast Name
Phone Number*

Area CodePhone Number
Reference #3*

First NameLast Name
Phone Number*

Area CodePhone Number
Age group you prefer to mentor*
List any ministry experience you have had (teacher, leadership, service roles, etc.)*
What interests you in becoming a mentor?*
What do you want to get out of mentoring?*
Summarize skills, qualifications, and/or training you have acquired from employment, education, life experience or through activities, including hobbies & sports. Also include passions and talents you would like to share with others. *
List community/social/ faith-based groups and organizations you are involved with.*
What behaviors do you find most frustrating in people?*
I am really good at...*
I am not so good at...*
In what areas of life are you trying to grow right now? *
Please tell us anything about yourself that you feel is important for us to know. *
Have you ever been addicted to a substance? If so, how long have you been substance free? Please briefly describe you addiction and treatment.*
I recognize that Graces of Gurley, Inc. is relying on the accuracy of the information I provide on this application form. Accordingly, I attest and affirm that the information I have provided is absolutely true and correct.

I authorize the organization to contact any person or entity listed on the application form, and I further authorize any such person or entity to provide the organization with information, opinions, and impressions relating to my background or qualifications.

I voluntarily release the organization and any such person or entity listed on the application form from liability involving the communication of information relating to my background or qualifications. I understand I will receive a notice regarding a background investigation from CHOICE SCREENING, and I will authorize the organization to conduct a criminal background investigation.

I understand that Graces of Gurley is a faith-based organization, and therefore, I will do nothing to contradict their religious beliefs while volunteering with the organization. Specifically, I will not engage in conversation, express opposing opinions, or share with our "neighbors" (clients/partners/volunteers) opposing views that contradict Graces' established set of beliefs. I agree to abide by and respect all the policies and procedures of the organization and to protect the health and safety of the people assigned to my care or supervision at all times.
Signature*

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