General Mentor Application

Mentor Application

We appreciate your interest in becoming a mentor. The information in this application will help us to determine your suitability for the program.

*We advise completing this application in one sitting, as the save function is limited. Browsers will store responses for a time until the application has been submitted.
Date *

Month Day Year
How did you initially learn about Save Our Youth? *

Mentor Church Presentation Board Google Staff Mentoring Connector
Name *

First Name Middle Name Last Name
Maiden Name or Aliases
Gender *

Male Female
Ethnicity *
Date of Birth *

Month Day Year
Age *
Email *
Address *

Street Address

Street Address Line 2

City State

ZIP
Cell Phone *
Home Phone
Language(s) Spoken *

English Spanish Swahili Kinyarwanda French
Military Experience *

Yes No
Marital Status *

Single Married Divorced Separated
Spouse Name *
Children *

Yes No
Names & Ages *
How long have you lived in Colorado? *
Years
Please list everyone living with you. (Include gender, age, occupation, & relationship.) *

Work Details
Occupation *
Company/Organization *
Length of Employment *
Years
Work Phone

Personal Information
List any special interests, skills, or hobbies you have. *
List examples of any prior volunteer experiences. *
Please explain any anticipation of future changes (family status, vocation, schooling, residency, etc.) & when they are expected to occur. *
Describe your personality. *

Medical History
List any major illnesses or medical issues. *
Have you ever sought counseling or psychological treatment of any type? *

Yes No
Please describe. *
Have you ever had problems with the use of alcohol or drugs? *

Yes No
Please describe. *

Spiritual Life
What parish or church do you currently attend? *
How long have you been involved there? *
Years
Please provide a brief explanation of your spiritual journey and your present relationship with God. *
What do you feel you have to offer a young person spiritually? *
What motivates you to work with at-risk kids? *

References
Please list 3 character references that are non-family. Include one professional reference, one personal reference, and one reference who can address your spiritual growth.
Name *

First Name Last Name
Relationship *
Phone Number *
Email *
Name *

First Name Last Name
Relationship *
Phone Number *
Email *
Name *

First Name Last Name
Relationship *
Phone Number *
Email *

Requirements & Background Check
Should you move forward to become a mentor, you will be asked to commit to the following. By signing below, you indicate your agreement.
- To meet weekly with your mentee for 1-3 hours.
- To serve as a mentor for a minimum of 1 year.
- To attend 3 hours of Mentor Training before being matched.
- To maintain monthly phone contact with a Save Our Youth Mentoring Specialist.
BACKGROUND CHECK

We are required to do an extensive background check through federal and state records of child abuse, criminal history records and driving records. We use IntelliCorp reporting agency to do this consumer report. Your social security number is needed in order to run this check.

Once you have attended Mentor Training, you will be given information about how to get your fingerprints done at your local IdentoGo. Once you do those fingerprints, we will receive the results from the Colorado Bureau of Investigation (CBI). This must be done before you will be assigned a mentee.
Social Security Number *
Have you ever been investigated for, charged, or convicted of a misdemeanor or felony? *

Yes No
Please explain the charge, date, and what it was regarding. *
Have you ever been investigated for, charged, or convicted of child abuse or neglect? *

Yes No
Please explain the charge, date, and what it was regarding. *
ACKNOWLEDGMENT & AUTHORIZATION FOR BACKGROUND CHECK

I acknowledge receipt of the separate stand-alone disclosure that follows and certify that I have read and understand it and this authorization. I hereby authorize the obtaining of “consumer reports” and/or “investigative consumer reports” by Save Our Youth at any time after receipt of this authorization and throughout my volunteering, if applicable. To this end, I hereby authorize, without reservation, any law enforcement agency, administrator, state or federal agency, institution, school or university (public or private), information service bureau, employer, or insurance company to furnish any and all background information requested by IntelliCorp Records, Inc., 3000 Auburn Drive, Suite 410, Beachwood, Ohio 44122; Tel. No. 1.888.946.8355; www.intellicorp.net.

Save Our Youth reserves the right to accept or decline volunteers based on the information gathered. For reasons of confidentiality Save Our Youth will only share reasons of denial if they involve the background or fingerprint check.

I certify that all the elements of the personal data I have provided are true, accurate and complete.
Name *

First Name Last Name
Signature *

Clear
Date *

Month Day Year
Date

Transportation
Do you have a valid driver's license? *

Yes No
Expiration Date *

Month Day Year
Date
Issuing State *
Do you have your own transportation? *

Yes No
Do you have current vehicle insurance as require by Colorado law? *

Yes No
If able, please submit a copy of your driver's license & insurance card. (Alternatively, this can be brought to training.)

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