• SupporTeen Youth, Inc.

    Mentor Application
  • SECTION ONE: GENERAL INFORMATION

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    Pick a Date
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  • SECTION TWO: EMPLOYMENT INFORMATION 

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  • SECTION THREE: Background Screening

    (this information is kept confidential and secure) 

    Will you agree to supply SupporTeen Youth, Inc. with a background check and also allow them to check through federal agencies for criminal record, child abuse, and neglect proceedings? 

     

  • SECTION FOUR: REFERENCES

  • Reference 1:

    Please list the names and phone numbers of two character references, plus one employer reference. Please list only non-relatives you have know for at least a year. 

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  • Reference 2:

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  • Reference 3:

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  • SECTION FIVE: MENTORING INFORMATION

  • Please read this carefully before submitting: 

    By submitting below, you attest to the truthfulness of all information listed on this application. You agree to let our puritan confirm all information listed and conduct a federal and state criminal record check.

     

    I understand the programs rules, regulations, and responsibilities for becoming a mentor. If submitted I will follow the rules of the program and be a dedicated mentor/volunteer.

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