Form
Volunteer Group Mentor Application 2024-2025
We are so glad you want to be a Mentor for Elementary or Teen Group Mentoring!
Please complete the below application and you will be contacted within 3 business days.
Name
First Name
Last Name
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Date of Birth
Gender
Please Select
Male
Female
Other
T-shirt size
Emergency Contact Name
Emergency Contact Phone Number
Your relationship with your Emergency Contact Person
How did you hear about our group mentoring program?
Which Group Mentoring Program do you want to be a mentor?
Please Select
Elementary Group Mentoring
Teen Group Mentoring
Why do you want to be a mentor in our group mentoring program?
Tell us a little about yourself-work, hobbies, how others would describe you.
Do you have experience with children? If yes, please explain.
What qualities, abilities or attributes do you have that would benefit a child/youth facing abuse or neglect?
Are you able to commit to the following 2025/2026 Group Mentoring dates: 9/13, 10/11, 11/8, 12/13, 1/10, 2/7, 3/7, 4/11, 5/09?
Please Select
Yes
No
Dates I am already committed elsewhere:
Describe your general health
Please Select
Good
Fair
Poor
Were you a victim of abuse, neglect or abandonment as a minor?
Please Select
Yes
No
Have you ever been arrested for a criminal offense?
Please Select
No
Yes
Have you ever looked at pornography featuring minors?
Please Select
No
Yes
Have you ever left or been asked to leave a role within an organization due to a concern regarding inappropriate conduct?
Please Select
Yes
No
Have you ever committed or been accused of any act involving the physical, sexual or emotional harm of another person?
Please Select
Yes
No
Have you ever been the subject of a DCFS investigation or are currently under investigation by DCFS?
Please Select
Yes
No
Have you ever had any kind of relationship with a minor or vulnerable adult that has brough sexual gratification to yourself?
Please Select
Yes
No
Are you dependent on any substance (other than prescription drugs) that you cannot go without during a four hour time period?
Please Select
Yes
No
Is there any circumstance or pattern in your life, or engagement in any behavior, which would compromise the integrity of our Group Mentoring program or make it difficult for you to serve as a role model with our children?
Please Select
No
Yes
Reference Name-1st of 3 references needed
First Name
Last Name
Reference Email-1st of 3 references needed
example@example.com
Reference Phone Number-1st of 3 references needed
Please enter a valid phone number.
Reference Name-2nd of 3 references needed
First Name
Last Name
Reference Email-2nd of 3 references needed
example@example.com
Reference Phone Number-2nd of 3 references needed
Please enter a valid phone number.
Reference Name- 3 of 3 references needed
First Name
Last Name
Reference Email-3 of 3 references needed
example@example.com
Reference Phone Number- 3 of 3 references needed
Please enter a valid phone number.
Do you understand that a background check will be run on you by Mission Church to verify your eligibility to serve as a mentor?
Please Select
Yes
No
Please attach a recent photo of yourself. If you're having any difficulty doing so, please contact Namon at Namon@rfk187.org.
Is the information contained in this mentor application correct to the best of your knowledge?
Please Select
Yes
No
Signature
Submit
Should be Empty: