Mentor Application & Screening Form

Big Bro Joe Foundation

Mentor Application & Screening Form
Thank you for your interest in serving as a mentor with the Big Bro Joe Foundation.

Our mentors help guide youth toward leadership, responsibility, and personal development through structured workshops and mentorship programs.

To ensure the safety and well-being of the youth we serve, all mentors must complete this application, pass a Washington State WATCH Background Check, and agree to our Youth Protection and Mandatory Reporting Policies.
SECTION 1 — Program Selection
Big Bro Academy (Mentoring Young Men)Big Sis Academy (Mentoring Young Women)
SECTION 2 — Personal Information
Name*

First NameLast Name
Other Names / Aliases Used
Date of Birth

MonthDayYear
Date
MaleFemale
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
SECTION 3 — Address Information
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
SECTION 4 — Emergency Contact
Emergency Contact Name*

First NameLast Name
Relationship*
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
SECTION 5 — Mentor Background
Why do you want to become a mentor with the Big Bro Joe Foundation?*
What personal qualities make you a good mentor for youth?*
YesNo
If yes, explain your experience.
SECTION 6 — Youth Interaction Experience
Mentoring programsCoaching sportsSchool programsYouth groups / churchAfter-school programsCommunity organizationsNo prior experience
SECTION 7 — Mentor Commitment
The Big Bro Joe Foundation mentoring program requires mentors to commit to:

• Two Saturdays per month

• 3–4 hour sessions

• Participation in youth workshops and activities

• Serving as a positive role model

Consistency is essential to building trust with youth participants.
I understand and agree to this mentor commitment
SECTION 8 — Additional Screening Questions
YesNo
If yes, please explain.
YesNo
If yes, please explain.
YesNo
If yes, please explain.
Is there anything in your personal or professional background that may affect your ability to serve as a mentor?*
SECTION 9 — References
Reference #1 Name*

First NameLast Name
Reference #1 Relationship*
Reference #1 Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Reference #2 Name*

First NameLast Name
Reference #2 Relationship*
Reference #2 Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
SECTION 10 — Youth Protection Policy
The Big Bro Joe Foundation is committed to providing a safe and supportive environment for all youth.

Mentors must agree to the following:

• Maintain appropriate boundaries with youth

• Avoid unsupervised one-on-one situations whenever possible

• Never engage in physical, emotional, or verbal abuse

• Never use inappropriate language or behavior around youth

• Never provide drugs, alcohol, or illegal substances

• Treat all youth with respect, dignity, and fairness

• Follow all program rules and supervision guidelines
I agree to follow the Youth Protection Policy.
SECTION 11 — Mandatory Reporting Policy
Mentors are considered trusted adults working with youth and must help protect the safety of all participants.

If a mentor suspects abuse, neglect, or harm toward a youth, they must immediately report the concern to:

• Big Bro Joe Foundation leadership

• Appropriate authorities when required by law

Failure to report suspected abuse may place youth at risk.
I understand and agree to comply with the Mandatory Reporting Policy.
SECTION 12 — Code of Conduct
Mentors agree to:

• Act with professionalism and integrity

• Demonstrate positive leadership

• Respect youth from all backgrounds

• Avoid profanity, discrimination, or harmful behavior

• Represent the Big Bro Joe Foundation positively
I agree to uphold the Mentor Code of Conduct.
SECTION 13 — Social Media & Communication Policy
Mentors should avoid private communication with youth through personal social media accounts.

Communication should occur through:

• Program activities

• Approved program communication channels

• Supervised environments
I agree to follow the communication policy.
SECTION 14 — Background Check Authorization
The Big Bro Joe Foundation conducts background checks through the Washington State Patrol WATCH system.

By signing this form, you authorize the Big Bro Joe Foundation to conduct a background check as part of the mentor screening process.
I authorize a Washington State WATCH Background Check.
SECTION 15 — Liability Acknowledgement
Participation in mentoring activities may include workshops, events, and community activities.

Mentors agree to participate responsibly and follow all safety guidelines.
I acknowledge and agree.
SECTION 16 — Electronic Signature
Signature*

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Date*

MonthDayYear
Date
Should be Empty:

Big Bro Joe Foundation

SECTION 1 — Program Selection

SECTION 2 — Personal Information

SECTION 3 — Address Information

SECTION 4 — Emergency Contact

SECTION 5 — Mentor Background

SECTION 6 — Youth Interaction Experience

SECTION 7 — Mentor Commitment

SECTION 8 — Additional Screening Questions

SECTION 9 — References

SECTION 10 — Youth Protection Policy

SECTION 11 — Mandatory Reporting Policy

SECTION 12 — Code of Conduct

SECTION 13 — Social Media & Communication Policy

SECTION 14 — Background Check Authorization

SECTION 15 — Liability Acknowledgement

SECTION 16 — Electronic Signature