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S.T.Y.L.E. Mentor Application
1.
Personal Information
Name
Address
Address 2
City/Town
State/Province
AL Alabama
AK Alaska
AS American Samoa
AZ Arizona
AR Arkansas
CA California
CO Colorado
CT Connecticut
DE Delaware
DC District of Columbia
FM Federated States of Micronesia
FL Florida
GA Georgia
GU Guam
HI Hawaii
ID Idaho
IL Illinois
IN Indiana
IA Iowa
KS Kansas
KY Kentucky
LA Louisiana
ME Maine
MH Marshall Islands
MD Maryland
MA Massachusetts
MI Michigan
MN Minnesota
MS Mississippi
MO Missouri
MT Montana
NE Nebraska
NV Nevada
NH New Hampshire
NJ New Jersey
NM New Mexico
NY New York
NC North Carolina
ND North Dakota
MP Northern Mariana Islands
OH Ohio
OK Oklahoma
OR Oregon
PW Palau
PA Pennsylvania
PR Puerto Rico
RI Rhode Island
SC South Carolina
SD South Dakota
TN Tennessee
TX Texas
UT Utah
VT Vermont
VI Virgin Islands
VA Virginia
WA Washington
WV West Virginia
WI Wisconsin
WY Wyoming
ZIP/Postal Code
Email Address
Cell Phone Number
2.
Alternative Phone Number
3.
Date of Birth
4.
Please list all members of your household over the age of 18.
Name
Sex (F/M)
Age
Relationship to Applicant
5.
Please list all members of your household over the age of 18.
Name
Sex (F/M)
Age
Relationship to Applicant
6.
Please list all members of your household over the age of 18.
Name
Sex (F/M)
Age
Relationship to Applicant
7.
Please list all members of your household over the age of 18.
Name
Sex (F/M)
Age
Relationship to Applicant
8.
Employment History: Please provide employment information for the past five years, with the most recent position held first. If more space is needed, please email separately to info@stylementoring.org.
Employer
Street Address
City
Zip Code
Supervisor's Name
Title
Phone Number
9.
Employment History: Please provide employment information for the past five years, with the most recent position held first. If more space is needed, please email separately to info@stylementoring.org.
Employer
Street Address
City
Zip Code
Supervisor's Name
Title
Phone Number
10.
Employment History: Please provide employment information for the past five years, with the most recent position held first. If more space is needed, please email separately to info@stylementoring.org.
Employer
Street Address
City
Zip Code
Supervisor's Name
Title
Phone Number
*
11.
Application Questions
Please answer
all
of the following questions as completely as possible.
Why do you want to become a mentor?
(Required.)
12.
Do you have any previous experience volunteering or working with youth? If so, please specify.
13.
What qualities, skills, or other attributes do you feel you have that would benefit a youth? Please explain.
14.
Can you commit to participating in the S.T.Y.L.E. Mentoring Program for a minimum of one year from the time that you are matched with a mentee with the possibility through high school graduation?
Yes
No
15.
Are you available to meet with a mentee eight hours per month and have contact at least once per week? Please explain any particular scheduling issues.
16.
How would you describe your personality?
17.
How would your friends, family, and co-workers describe you?
18.
Are you willing to communicate regularly and openly with program staff, provide monthly information regarding your mentoring activities, and receive feedback regarding any difficulties during your participation in the mentoring program?
Yes
No
19.
S.T.Y.L.E. Mentoring Program appreciates your interest in becoming a mentor. Please initial each of the following.
I agree to follow all mentoring program guidelines and understand that any violation will result in suspension and/or termination of the mentoring relationship.
I understand that S.T.Y.L.E. Mentoring Program is not obligated to provide a reason for their decision in accepting or rejecting me as a mentor.
(Optional) I agree to allow S.T.Y.L.E. Mentoring Program to use any photographic image of me taken while participating in the mentoring program. These images may be used in promotions or other related marketing materials.
I agree to attend the initial mentor training session and in-service training session per year after being matched.
20.
I understand I must return all of the following completed items along with this application, and that any incomplete information will result in the delay of my application being processed.
- Copy of your valid driver's license
- Information Release Form (I-CHAT)
- Interest Survey Form