Name of Applicant
First Name
Last Name
Date of birth
Highest Educational Attainment
Job title/position
Are a member of a sorority? List here.
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
How did you hear about us?:
*
Facebook
Volunteermatch
Instagram
Website
Nextdoor
Other
What type of mentorship are you interested in? (You can choose more than one!) (select all that apply): Note: All mentors (except professional mentors/facilitators) must be willing to commit to a 12-month program, participating in one in-person and one online session each month
*
One-on-One Mentors for girls ages 12–17
Group Mentor for mother-daughter pairs
One-on-One Mentors for mothers, guardians, caregivers
Professional Mentors/facilitator in areas like wellness, confidence, education, and leadership
Please check any of the following skills or areas you feel confident in and would be willing to share as a mentor (select all that apply):
*
Career Planning
Active Listening
Work-life balance
Resume Writing
Leadership
Community Engagement
Dispute Resolution
Strategic Planning
Life Skills development
Finance Management
Computer Literacy
Education
Public Speaking
Arts/Craft
College & Career Prep
Other
Based from your choices above, please describe the areas which you can be helpful of in providing mentoring.
What special skills, talents, or hobbies would you like to share with your mentees?
Why are you interested in mentoring with the B.A.G.S. Program?
What personal qualities or values do you believe are important in a mentor?
Have you mentored before? If yes, please describe the experience.
What experience do you have working with youth, especially girls aged 12–17?
Are you open to mentoring a mother-daughter duo? Daughters range in age from 12 to 17.
Yes
No
Are you comfortable discussing sensitive topics such as self-esteem, relationships, or social media safety with youth?
Is there any characteristic in a mentee that you may be uncomfortable handling? Please specify.
Do you have any restrictions that would prevent you from volunteering with youth?
Yes
No
Have you ever been convicted of a crime, pled nolo contendere (no contest), or are there any criminal charges currently pending against you? (Note: A conviction does not necessarily disqualify you from participation. All information will be kept confidential and evaluated on a case-by-case basis.)
Yes
No
If yes, please explain.
To help our organization conserve our limited resources, would you be willing to cover the cost of your background check and t-shirt (up to $70) $45-background check, $20 t-shirt up to XL or $23 2X or larger ?"
Yes
No
By and signing and submitting this application you acknowledge and agree to the following: 1. Background Check ConsentI understand that, as part of the application process, The Chosen Ones, Inc. requires a criminal background check. I authorize The Chosen Ones, Inc. or its representatives to conduct a background check, and I understand that I am responsible for the cost. 2. Confidentiality Agreement I agree to maintain the confidentiality of all information I may learn about mentees, their families, and program matters while volunteering with The Chosen Ones, Inc. 3. Non-Discrimination StatementI agree to treat all mentees with respect, dignity, and fairness, without regard to race, gender, religion, sexual orientation, disability, or socioeconomic status. 4. Liability Release I understand that participation in the mentoring program is voluntary, and I release and hold harmless The Chosen Ones, Inc., its employees, officers, directors, and agents from any liability, claims, or damages arising from my participation in this program, except in the case of gross negligence or willful misconduct. 5. Mandatory Reporting AcknowledgmentI acknowledge that I may be considered a mandated reporter under state law and agree to report any suspicion of abuse, neglect, or exploitation to the appropriate authorities and The Chosen Ones, Inc. leadership immediately. 6. Truthfulness StatementI certify that all information provided in this application is true and complete to the best of my knowledge. I understand that any false statements, omissions, or misrepresentations may result in disqualification from the program.
Yes
No
Signature
Date
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Month
-
Day
Year
Date
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