Become a Mentor
Mentorship Application | Arizona-Based Youth Support
Full Name
Date of Birth
-
Month
-
Day
Year
Date
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Do you have a valid Arizona state-issued ID or Driver’s License? If yes upload a copy
Yes
No
File Upload
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Are you authorized to work in the United States?
Yes
No
Have you lived in Arizona for at least 6 months?
Yes
No
Do you speak any other languages besides English?
Highest Level of Education Completed
Please Select
High School Diploma
GED
Associate's Degree
Bachelor's Degree
Master's Degree
Other
Current Employment Status
Please Select
Employed
Full-Time
Part-Time
Unemployed
Self-Employed
Student
Current or Most Recent Employer
Upload Resume or LinkedIn Profile
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Have you mentored youth before?
Yes
No
If yes please describe your experience
Why do you want to become a mentor with Ever-Change Consulting?
What age range do you feel most comfortable mentoring?
Please Select
12-14
15-16
17-18
Young Adults
What topics are you passionate about mentoring on?
Academic Success
Emotional Wellness
Leadership
Conflict Resolution
Career/Vocational Exploration
Substance Prevention
Confidence/ Self Worth
Other
Do you consent to a Level 1 Fingerprint Clearance Card background check? Required by Arizona Department of Child Safety
Yes
No
Do you have an active Level 1 Fingerprint Clearance Card?
Yes
No
If no, are you willing to apply?
Upload a copy Fingerprint Clearance
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Do you consent to a child abuse and neglect background check through Arizona Department of Child Safety (DCS)?
Yes
No
Have you ever been convicted of a felony?
Yes
No
If yes, please explain:
Are you available to mentor a minimum of 2–4 hours per month?
Yes
No
Preferred Mentorship Format
Please Select
1:1 In- Person
1:1 Virtual
Group Sessions
No Preference
Availability
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Time of Day
Morning
Afternoon
Evening
Reference 1
Reference 2
Code of Conduct Agreement
*
I understand that mentoring youth requires professionalism, confidentiality, and compassion. I agree to comply with Ever-Change Consulting’s policies, expectations, and Arizona state guidelines for working with minors.
Mandatory Reporter Acknowledgement
*
I acknowledge that as a mentor, I am a mandatory reporter under Arizona law and must report any suspected abuse or neglect
Consent to Training & Evaluation
*
I agree to participate in all required onboarding trainings and periodic evaluations
Signature
*
Date
-
Month
-
Day
Year
Date
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