Mentor Application

Thank you for your interest in becoming a Mentor with Companions for Children. After submitting the information below, our staff will be in contact to complete the screening process.

Contact Information

First Name *This question is required.

Middle Name *This question is required.

Last Name *This question is required.

Preferred Name (if different from above):

Pronouns *This question is required.

If you said other, please specify. *This question is required.

Date of Birth *This question is required. MM/DD/YYYY This question requires a valid date format of MM/DD/YYYY.

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Street Address *This question is required.

Apt/Suite

City *This question is required.

Zip *This question is required.

Email Address *This question is required. This question requires a valid email address.

Cell Phone Number *This question is required. Please provide a 10-digit phone number including area code.
Enter numbers only. Formatting such as dashes will be added as you enter your phone number.

Click yes if you consent to receiving text messages. *This question is required.

Work Phone Number:

Secondary Contact - Please provide a secondary contact. If approved, we will use this contact if we are unable to get in touch with you for an extended period of time. (I.e. roommate, coworker, close friend, etc.)

First and Last Name *This question is required.

Email Address *This question is required. This question requires a valid email address.

Phone Number *This question is required.

Relationship *This question is required.

Facebook Handle

Instagram Handle

Military Service *This question is required.

What is your squadron? *This question is required.

What is your current rank? *This question is required.

What is your job/position? *This question is required.

If approved, will you be reporting your volunteer hours on your EPR? *This question is required.

I understand that if I am reporting my volunteer hours on my EPR that I must obtain an official summary of my volunteer hours by requesting the information from Companions for Children staff. *This question is required.

Tribal Affiliation *This question is required.

What tribe? *This question is required.

If you said other, please specify. *This question is required.

Where are you employed? *This question is required.

Drivers' License *This question is required.

Drivers' License Expiration Date: *This question is required. MM/DD/YYYY This question requires a valid date format of MM/DD/YYYY.

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Drivers' License ID #: *This question is required.

What program are you applying to? *This question is required.

Mentor Application

Welcome