2026 Mentor Application to Interview

2026 Summer Retreat Mentor Application

Please fill out the questions below to be considered for an interview.
Volunteering at Empowerteen!

Thank you so much for applying to volunteer at the Empowerteen Retreats this summer as a Big Sib Mentor. Your contribution is an important asset to the program and the participants' experience while at the retreats.

Mentors will receive credit for their work along with a reference letter from Dr. Paula when requested based on your performance during your time in this position. Be sure to choose what type of credit you are interested in receiving below: Volunteer Hours, or Community Service hours, or College Internship hours.

This is a great opportunity for individuals who are fun role models, who show leadership skills or are looking to develop these skills, and love contributing to the larger community. An understanding and passion for mental-physical-social-emotional health, working with this age population, and spreading awareness about this beneficial program to the community makes you an ideal candidate. Empowerteen Alumni are given preference for the position, as well.

• Each retreat week runs for 5 days (Monday through Friday) from 10am-4pm. We meet each day of the retreat week at 9:15am, at Scholls Valley Lodge in Beaverton, OR, and do a follow-up meeting until 4:45pm each day.

• If you are able to show up earlier on the first day (Monday) or stay later on the last day (Friday) it is appreciated in order to help Dr. Paula load and unload supplies and props and clean up at the location. You will be given credit for these extra hours if you choose them.

• There is a High School Retreat July 13-17, 2026; and a Middle School Retreat July 27-31, 2026.

Please confirm below the retreats you will be applying to mentor at, answer the short essay questions, fill out the information intake, and sign the application to submit.

Upon submission, you will be contacted via email from dr.paula@empowerteen.org regarding setting up a virtual Zoom interview date. Keep an eye out for this email to come within 24-48 hours. Interview spots will be filled on a first-come, first-served basis.

Dr. Paula is looking forward to interviewing you as a new mentor candidate with Empowerteen for the 2026 year!
Please SELECT the retreat(s) you are available to mentor for

Other
I am looking for credit hours for my volunteering:

Other
Applicant's Name
First Name
Middle Name
Last Name
Nickname
Date of Birth:

MonthDayYear
Date
What is the highest Educational Level you have completed so far?

Other
Gender

Other
Preferred Pronouns

Other
What is your transportation situation?
Do you have a Driver's License? Do you have a car? Can parents drive you to/from camp? Are you comfortable taking public transportation like TriMet buses or the MAX? Will you be looking for a carpool situation?
Applicant's Intent
Why do you want to be an Empowerteen Mentor?
i.e., what does the mentoring role mean to you?
What unique qualities do you bring to the role of Big Sib Mentor?
i.e., what do you bring to the table that will benefit participants and fellow mentors?
How do you think being a mentor will help you grow as a person?
i.e., what do you hope to gain from this experience?
What do you think is most important in a participant's experience at Empowerteen?
i.e., what is it that a teen participant shouldn't leave a retreat without?
Applicant's Information
Address
City
State
Zip
Phone (for contacting if needed regarding interview)

Area CodePhone Number
Email (for sending/receiving interview-related items)
example@example.com
Emergency Contact Name
Emergency Contact Number

Area CodePhone Number
Emergency Number #2

Area CodePhone Number
We're so glad you found us!
Have you attended an Empowerteen event before, or are you new to Empowerteen? (events include retreats, classes, workshops, field trips, fundraisers and socials)
How did you originally find out about Empowerteen?

Other
If you were referred to Empowerteen, by whom were you referred?
Acknowledgement of Requirements:
I understand that I am required to be present for every day of the retreat week to which I commit if accepted:

Other
I understand that I am required to be present at the mentor orientation and training meeting if accepted (90 minutes on July 11th, 2026):

Other
I have transportation to/from both of the retreat locations each day of the retreat week if accepted:

Other
Parent or Legal Guardian Information

If you are under the age of 18, please fill out the following information.
Parent /Legal Guardian

First NameLast Name
Relation
Guardian's Work Phone

Area CodePhone Number
Guardian's Cell Phone

Area CodePhone Number
Guardian's Email (retreat confirmation and announcements will be sent by email)
Parent /Legal Guardian 2

First NameLast Name
Relation 2
Work Phone 2

Area CodePhone Number
Cell Phone 2

Area CodePhone Number
Health Information
It is our policy to contact the emergency contact as soon as possible in the event of a serious accident or injury. If we cannot get ahold of anyone after this process, we will activate emergency services by calling 911 if necessary. It is your responsibility to let us know if we need to be aware of potential health issues that may arise as you volunteer for this summer retreat, and any modifications that are needed to prevent emergency situations.
1. We will be doing activities and exercises that include stretching, strengthening, and vigorous movement. Do you have any physical restrictions related to this? (ie., Injuries, Scoliosis, Pinched Nerve, Blood Sugar or Blood Pressure concerns, etc.)
2. If you answered YES to the question above please list these restrictions in the box below. If NO, select N/A

Other
3. We will be doing outdoor activities most of the time. Do you have any allergies to gardens with bees, flowers, insects, pollens, grasses, and other outdoor allergens?
If you answered YES to the question above, do you need any medications related to this? (ie., Benadryl, Asthma Inhaler, Anti-Histamine, Epi Pen, etc.)

Other
"I understand that during the retreat week it is my responsibility to tell Dr. Paula if I am experiencing any primary or secondary symptoms including fever over 99F, chills, cough, shortness of breath, difficulty breathing, loss of taste/smell, sore throat, headaches, muscle/body aches, fatigue, nausea/vomiting, congestion/runny nose, sinus pressure, diarrhea or any symptom that is unusual or new for me because I want to protect the participants, volunteers, and the integrity of the retreat."

Other
All fileds are required below. If nothing applies, please put "NONE" in the box. Thanks.
Is there any activity or lesson topic with which you feel uncomfortable?
Is there any physical, mental or other condition now or in the past that would require special attention, consideration, or medication while mentoring at the retreat?
Volunteer Release Form

Please read and sign below.
By hitting submit and signing this form, I agree that I am over the age of 18 or I am the parent or legal guardian of the above named teen volunteer and all the information entered into this form is true and correct with nothing omitted. I agree that if any of this information changes that I will notify Empowerteen so in writing before the start of the retreat I am assigned to. In case of medical emergency or general medical care, I give consent for medical teatment for myself or for the aboved named teen volunteer by authorized personnel. I understand that the information I am privy to is confidential and any information shared by a partcipant will not be shared other than within the camp staff and Dr. Paula. I authorize Empowerteen to use my picture, testimony, and video in any promotional material (web, print, or media). If I am 18 years old or older, I give permission to Dr. Paula to run a standard background check to have on file for the safety of participants. I understand the inherit risks involved with physical activity, mental/emotional activity, social actvity, and engaging online, and I agree not to hold Empowerteen, 11-22 Integrative Medicine, or Dr. Paula Pilcher liable. I am aware that if I do have concerns, that it is my responsibility to have engaged contact with Dr. Paula to address them. Therefore this signature will also serve as my informed consent and waiver. I understand that by signing this contract I agree to attend all the agreed upon requirements if accepted.

I understand that if I am offered this opportunity and I do not follow through with this committment, I put Empowerteen in a bind and promise to do my best to find a replacement for my position.
I certify that the information I entered on this application form is correct, and agree with the Volunteer Participant Release statements above. (Signature in box below)

Signature is manually required above.
Be certain to enter your email address correctly on the application form to receive invitation to interview via email.
Should be Empty:

2026 Summer Retreat Mentor Application

Applicant's Name

Applicant's Intent

Applicant's Information

We're so glad you found us!

Acknowledgement of Requirements:

Parent or Legal Guardian Information

Health Information

Volunteer Release Form