Mentor Application

Mentor Application
This form will take an estimated 15-20 minutes to complete and will require photograph proof of Driver License and Auto Insurance. Before you start this application, please have both of those ready.
Legal Name

First NameMiddle NameLast Name
Date of Birth*

MonthDayYear
Date
Sex*

MaleFemale
Pronouns*

She/her/hersHe/him/hisThey/them/theirOther
Race/Ethnicity
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Preferred Number*
Please enter a valid phone number.
Alternate Number
Please enter a valid phone number.
Email*
example@example.com

What are your personal values and how do you believe they will help you be a good mentor to a teen in foster care?*
What has motivated you to commit to the HOPE585 Youth Mentoring Program?*
What are you hoping to achieve through mentorship? *
Will you be comfortable and capable of mentoring youth with differing backgrounds, religions, lifestyles, etc. from your own?*

References

(If retired or self-employed, please provide personal references and/or a past or present professional reference)
Professional reference:
Name*

First NameLast Name
Email*
example@example.com
Cell Phone*
Please enter a valid phone number.
Alternate Phone
Please enter a valid phone number.
Position*
Years Known*
Non-family friend for 5+ years:
Name*

First NameLast Name
Email*
example@example.com
Cell Phone*
Please enter a valid phone number.
Alternate Phone
Please enter a valid phone number.
Years Known*
Non-family friend for 5+ years:
Name*

First NameLast Name
Email*
example@example.com
Cell Phone*
Please enter a valid phone number.
Alternate Phone
Please enter a valid phone number.
Years Known*
Employer
Your Present Occupation*
Present Employer*
How long have you had this job?*

This form will take an estimated 15-20 minutes to complete and will require photograph proof of Driver License and Auto Insurance. Before you start this application, please have both of those ready.