Be A Mentor  | Mentor application  | Online application

Fields marked with  * are required

Personal Information

Title First Name * Middle Name Last Name * Suffix

Contact Information

Email * Street Address 1 * Street Address 2
City * State * Zip * Country
Phone Number *
Employer Occupation
Month Day Year
Date of Birth *
Gender *     

Employment Information

If employed, what is your title/position held?
Work Address
Work Phone Number
Work Email Address
Supervisor's Name
Years at current employer


Previous Employer (if less than 3 years at current position)


Address
Years at this employer
What is the best way to contact you      


How do you identify yourself, including, but not limited to, religious and ethnic heritage?

Education and Training

High School Attended
Year of Graduation
College Attended
Degree & Year Attended
Other Education and/or Special Training

Language Skills

Do you speak any languages other than English?          
If so, please indicate the language and level of reading, written, and oral proficiency


Volunteer Experience

Please list any prior volunteer experience. Include volunteer organization, date started/completed and activities performed

Have you applied to be a mentor with Mentoring USA in the past? *    
If yes, When

Please choose the site(s) that you are interested in

1st Choice *
2nd Choice *
3rd Choice *

Application Questions

Your responses to the following questions will help us determine whether you are a good fit for a Mentoring USA program and will help to match you with a mentee.

Do you have any experience volunteering or working with youth? If so, please specify *


What qualities, skills, or other attributes do you feel you have that would benefit a youth? *


What do you think will be the most challenging thing about being a mentor? *


What do you hope to gain from becoming a mentor? *



Do you have an age preference for your mentee?      
If so, please specify why you prefer this age

Do you have any disabilities that may affect your involvement in the program? *             
If so, please specify

How did you hear about Mentoring USA?  *

If Other, please specify

References


Please list three (3) references who you have known for at least one (1) year. One of these refrerences must be your current supervisor, if applicable. Relatives or Family members cannot be used as references. Please give complete addresses and phone numbers. References will be contacted by phone or mail. The information furnished to us by your references will remain strictly confidential. References are REQUIRED.

Reference 1
Name *
Relationship *
Phone Number *
Years known *

Reference 2
Name *
Relationship *
Phone Number *
Years Known *

Reference 3
Name *
Relationship *
Phone Number *
Years Known *

Additional Personal History

Does your employer promote volunteer activities? If yes please explain.

Please indicate if you are willing to approach your employer about any of the following:




Are you adopted? *

   
Have you been through the foster care system? *         

If you answered yes to either of the two questions: would you be interested in mentoring a young person in Foster Care or who is in the process of being Adopted?            

Background Screening

Mentoring USA's Mentors work with children. Therefore, we are required to screen our volunteers. Please respond to the following questions. Be aware that further screening paperwork as well as fingerprinting along with our mentor contract will be completed by all mentors at our Best Practices Training.

Mentoring USA allows applicants to disclose a criminal record during the application process. Having a criminal history does not preclude an individual from mentoring, however if it is not truthfully disclosed he/she will be considered ineligible to mentor. For further information please review our Screening Process(:Link to Screening Process)

Have you ever been charged/indicted for any crime? *              
If yes, please supply details


Thank you for answering all our questions, you are almost done. Please review your answers and click the submit application button. Once you submit your application you will receive an email confirmation with next steps and other important information.