Brickfire Project Mentor Application Form
FALL 2018 - APPLICATION DUE AUGUST 31, 2018.
Name
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First Name
Last Name
Gender
*
Male
Female
If you are a member of an organization (such as Day One, Montgomery Leadership, Lambda Sigma, etc.) or receiving field/practicum hours for an MSU class, please list the full name/class name and course code here. If this does not apply to you, put "N/A."
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MSU Email
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abc123@msstate.edu
Phone Number
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-
Area Code
Phone Number
Home Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What is your current classification?
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Freshman
Sophomore
Junior
Senior
What is your major?
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What social media accounts do you actively use? Check all that apply.
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Facebook
Instagram
Snapchat
Twitter
I do not have any social media accounts.
Other
Please list your name/username of EACH social media account you checked above.
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Example: Instagram: abc_123
The minimum time requirement to be a mentor is 1 day a week for at least 1 hour on the day(s) that you go. You can go any day from Monday-Friday for at least an hour between 3:30 and 5:30 p.m. Are you able to commit to this minimum time requirement?
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Yes
No
How many days (Mon - Fri) can you commit to coming each week? 1 day is the minimum, 5 days is the maximum.
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1
2
3
4
5
Select which day(s) of the week you are available to come mentor. In other words, select which day(s) of the week you wouldn't mind being scheduled to come mentor each week. **You will only be scheduled for as many days as you said you would like to commit to.
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Monday
Tuesday
Wednesday
Thursday
Friday
List the earliest time you can arrive for each day you are available. **3:15 p.m. is the earliest arrival time. **4:30 p.m. is the latest arrival time.
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Have you previously served as a Brickfire Mentor?
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Yes
No
If no, what age group would you prefer to work with?
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Kindergarten - 2nd grade
3rd - 6th grade
I can work with either.
If yes, how many semesters have you previously served as a Brickfire Mentor?
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1 semester
2 semesters
3 semesters
4 semesters
5 semesters
6 semesters
7 semesters
8 semesters
If yes, who was your assigned mentee of Spring 2018?
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If yes, would you like to continue working with your previously assigned mentee?
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Yes
No
If you would NOT like to continue working with your previously assigned mentee please explain 1) why and 2) who you would possibly like to work with instead. If this does not apply to you, please type "N/A."
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List any other organizations you are currently involved in and/or plan to be involved in during the 2018 Fall Semester?
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MSU organizations, church involvement, job, etc.
List and explain any previous experience you have volunteering, mentoring, or working with youth.
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Why do you want to be a mentor? (3 sentence minimum)
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What would an ideal mentor-mentee relationship include? (3 sentence minimum)
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What is the most important advice you could share with a mentee? (3 sentence minimum)
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What skills and interests do you have that you’d like to share with a mentee?
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traveling, sports, books, academics, instruments, dance, cheer, etc.
Please upload college resume here.
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SIGNATURE DISCLAIMER: I certify that my answers are true and complete to the best of my knowledge. If this application leads to a mentoring position, I understand that false or misleading information in my application may result in rejection of my application or termination of my mentor position. I have read, understand, and by my signature below consent to these statements.
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