ElevateHER Network, Inc. Mentor Application Form

ElevateHER Network, Inc. Mentor Application Form

Thank you for your interest in becoming a mentor with ElevateHER Network,Inc. Our mentors play a vital role in shaping the confidence, leadership, andfuture of the girls we serve. Please complete this application thoroughly andhonestly. All information will be kept confidential and used solely forscreening and program purposes.
Full Legal Name

First NameLast Name
Preferred Name (if different)
Date of Birth

MonthDayYear
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Current Job Title and Organization
Briefly describe your professional background
Why do you want to be a mentor with ElevateHER?
Age groups you feel most comfortable working with
What qualities make you a strong mentor?
How would you handle conflict between mentees?
What does empowerment mean to you?
Have you mentored others before?
Please describe your previous mentoring experience (if any)
Are you willing to complete required mentor training?
How many hours per month can you commit to mentoring?
What is your preferred method of mentoring?
How long are you able to commit to mentoring?
Days/Times Available:
Are you willing to attend scheduled program sessions consistently?
Criminal History Disclosure & Background Authorization
ElevateHER Network, Inc. is committed to maintaining a safe and secure environment for all participants. The safety of the girls we serve is our highest priority.
Have you ever been convicted of, pleaded guilty to, or pleaded no contest to any felony or misdemeanor (excluding minor traffic violations)?
If yes, please provide the date, nature of offense, and disposition:
A conviction does not automatically disqualify you from consideration. Each disclosure will be reviewed on a case-by-case basis, considering the nature of the offense, the date, and its relevance to youth mentoring. Failure to disclose relevant criminal history may result in immediate disqualification or termination from the program.
Mentor Commitment Agreement
If selected, I agree to:

• Uphold the mission and values of ElevateHER Network, Inc.

• Maintain confidentiality and appropriate boundaries

• Participate in required training

• Follow all policies and procedures

• Report any concerns regarding participant safety immediately

• Serve as a positive, ethical, and consistent role model.
Signature
Date

MonthDayYear
Date
For Office Use Only
Application Received

MonthDayYear
Date
Background Check Completed

MonthDayYear
Date
Reference Checks Completed

MonthDayYear
Date
Approved
Reviewer Signature
Should be Empty:

ElevateHER Network, Inc. Mentor Application Form

Criminal History Disclosure & Background Authorization

Mentor Commitment Agreement

For Office Use Only