4G SENIOR MENTOR APPLICATION
The Children & Youth Prevention - Empowerment Network (CYPEN) is seeking senior women 55+ to assist with newborn children and mentor young mothers. If interested, please complete the following application. A CYPEN representative will contact you within 24 hours upon receipt of your application.
Applicant name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Email
*
example@example.com
In which capacity do you prefer to serve?
*
Mentor Only
Assist with Newborn Only
Both Mentor & Newborn Assistant
How many hours per week would you be available to mentor a young woman?
*
1 - 2 hours per week
2 - 4 hours per week
5+ hours per week
How many hours per week would you be available to assist with newborn children?
*
1 - 2 hours per week
2 - 4 hours per week
5+ hours per week
Will this be your first time participating in a mentoring program?
*
Yes
No
If no, in what capacities have you served as a mentor or had a mentor yourself, and what was your experience like?
Why do you believe you would be a strong mentor?
Please provide any other information you believe would be important in review of this application.
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