My Sister's Keeper (MSK) & My Brother’s Keeper (MBK)

To become a mentor or volunteer with My Sister's Keeper and My Brother's Keeper, complete this application and a representative will follow up with you. Thank you for your interest!

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* 1. First Name

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* 2. Middle Name

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* 3. Last Name

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* 4. Birthday

Date

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* 5. Driver's License#

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* 6. Auto Insurance Carrier/Policy#

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* 7. Organization/School (if applicable)

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* 8. Address/City/State/Zip

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* 9. Home phone number

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* 10. Cell Number

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* 11. Email Address

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* 12. Employer/Last Employer

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* 13. Employer Address

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* 14. Education Background/School

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* 15. Referred by

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* 16. What is your motivation for becoming a mentor and working with MSK/MBK?

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* 17. Do you have personal or professional experience working with youth? Participating in youth programs? Yes/No If so, give us details.

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* 18. Do you possess any special skills, talents, abilities, or resources which you would like to contribute? Yes/No if so, please list:

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* 19. In what area(s) of the organization would you like to serve? Or what would you bring to be an added benefit to the organization and our youth?

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* 20. Please provide three personal and professional references. List full name, relationship, and phone number.

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* 21. Upload your resume here.

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* 22. I agree to serve as a mentoring associate of My Sister's Keeper and My Brother's Keeper. I will fully and actively support the mission, core values, objectives, and organizational goals of My Sister's Keeper. I will follow mentoring best practices as outlined by the nationally recognized organization, MENTOR. I consent to Michigan Central Registry clearance and background checks as needed to protect the interests of youth participants and stakeholders. I indemnify and hold My Sister's Keeper and My Brother's Keeper, its administrators, board, staff, mentors, volunteers, agents, and partners harmless and NOT responsible or liable for any accident, incident, injury, or loss resulting from my participation. I waive my right to seek legal action or any form of recourse against My Sister's Keeper or its affiliates. As an MSK/MBK mentor and advocate, I vow to aid in the fight to "KEEP" our youth on the path to success.

Type your full name and date below which will serve as your signature.

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