Mentoring for Leadership

Personal Information

First Name *

Last Name *

Date of Birth *

Gender *

Address *

Email Address *

Phone Number *

Ethnicity

Marital Status

Highest Level of Education

Employment

Employer

Occupation

Work Address

May we contact you at work?

YesNo

About You

How did you learn about MFL?

Motivation for wanting to be a mentor *

Have you volunteered with any other organization?

What languages are you comfortable speaking?

Select all that apply

Your Interests

Select all that apply

Have you ever been convicted of a crime? *

YesNo

References

Please provide two references.

Reference 1

First Name

Last Name

Address

Email Address

Phone Number

Relationship

Reference 2

First Name

Last Name

Address

Email Address

Phone Number

Relationship

Photo Release

I give permission for photos and/or videos of me to be used by Mentoring for Leadership for promotional and educational purposes.

Mentor Agreement

I understand that:

The references I listed will be contacted by mail, email, or telephone.
The information I provided will be used to conduct a background check, to include criminal background, sexual offender, and child abuse registry checks and other records where required by local, state, or federal law for certain individuals who may interact with participating minors.
The completion of this volunteer application does not obligate me to perform any volunteer services.
The mentoring program is not obligated to match me with a youth.
The mentoring program is not obligated to provide a reason for its decision in accepting or rejecting my application to be a mentor.
Other youth organizations where I have worked or volunteered may be contacted as references.
As part of the enrollment process, I may be asked to provide additional personal information prior to any recommendations for assignment (such as social security number, valid driver's license or ID, fingerprints, or proof of auto insurance), if requested.
I am required to follow all mentoring program guidelines and policies and understand that any violation will result in suspension and/or termination of the mentoring relationship.

By checking ‘Yes’, I am agreeing to all the statements above and certify that all elements of the personal data I have provided are true, accurate, and complete. I understand and agree that any omission, false statement, misleading statement, or answer made by me on my application or any supplements to it or in any interviews will be sufficient grounds for rejection for consideration as a volunteer. *

YesNo

Signature *

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Become a mentor

Reference 1

Reference 2