IVM Mentor App

IVM Mentorship

Impact Valor Mentorship Program • Fresh Impact Church - Men of Valor
Mentor Application
Thank you for your interest in becoming a mentor with Impact Valor Mentorship. This program is designed to provide guidance, support, and encouragement to young men ages 12-18. Please complete the application below to be considered for the program. A background check is required for all mentors.
Full Name
Date of Birth

MonthDayYear
Date
Phone Number
Address
City
State
Zip
Email Address
example@example.com
Occupation
Employer
Marital Status
Do you have any children?

YesNo
If yes what are their ages
Are you a member of Fresh Impact Church?

YesNo
If no where do you attend church?
How long have you attended?
If yes which ministries?
Have you previously mentored a young person?

YesNo
If yes please describe your experience?
Why are you interested in becoming a mentor?
What qualities do you believe make a great mentor?
Do you have any specific skills or interests you would like to share with a mentee? (Check all that apply):
Type a question

SportsMusicBusiness/EntrepreneurshipTechnologyBible Study/Spiritual GrowthType option 5Other
Have you ever been convicted of a crime?

YesNo
If yes please explain
Do you consent to a background check?(If no, you will not be eligible to participate in the program

YesNo
Please provide two references (one personal, one professional or pastoral):
Reference #1 Name
Reference #1 Phone Number
Relationship to Reference #1
Reference #2 Name
Reference #2 Phone Number
Relationship to Reference #2
Commitment Agreement: I understand that participation in the Impact Valor Mentorship program requires a commitment of six months, with the option to continue for an additional six months. I agree to:
- Call my mentee once per week.
- Meet in person with my mentee once per month.
- Attend quarterly gatherings with other mentors and mentees.
- Provide encouragement, guidance, and support to my mentee.
- Adhere to the program's code of conduct and expectations.
Signature

Clear
Date

MonthDayYear
Date
Thank you for your application. A representative from Impact Valor Mentorship will contact you regarding the next steps.
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Mentor Application