This is Me Volunteer Mentor Application

Contact Information

First Name *This question is required.

Last Name *This question is required.

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

calendar

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.

Primary Phone Number *This question is required. 555-555-5555

If you said other, please specify.

Why do you want to be a This Is Me mentor? *This question is required.

What experience do you have working with Children 7-18? *This question is required.

What experience do you have working with the foster care system? (you don’t need experience – we can teach you that). *This question is required.

Are you interested in working with any children that may fall into these categories?

LGBTQ
Racially diverse
Anxiety/Depression
Behavioral Concerns

Do you speak another language? *This question is required.

If Yes, what languages?

If Other, please specify:

Do you have transportation if needed to get to and from your mentee? *This question is required.

To help you match with a little buddy that has similar interests and personality traits, please check all that apply: *This question is required.

Tell us about your interests, hobbies, clubs and the organizations you’re involved in and what you might like to share or do with your mentee.
*Please list at least 5. *This question is required.

Is there anything about your background that would be helpful in relating to certain children (i.e. bi-lingual, heritage, divorced parents, foster care, chemical dependency, trouble academically, love for certain sport, music or hobby, etc)? *This question is required.

Have you ever been the subject of an investigation regarding illegal drugs or criminal or sexual activities against children? *This question is required.

If yes, please explain (offense, date, location, circumstance, and outcome): *This question is required.

Have you lived in this country for at least the last 5 years? *This question is required.

If no, please explain: *This question is required.

This is Me Volunteer Mentor Application

Request to be a This is Me Volunteer Mentor