Mentoring Application- 2021 Survey

Impact Mentoring- Mentor Application 2021-22

Parents/Caregivers
Your child has been nominated to be a mentor in our Impact Mentoring program! Impact Mentoring is a program operated by Butte County Department of Behavioral Health and we would love to provide you with some information about our program. We are currently recruiting mentors for this upcoming school year. Our Impact Mentoring program consists of 20 sessions. The 20 sessions include goal setting, skill sessions facilitated by mentors and one-on-one time between mentors (high school students) and protégés (junior high students). Each mentoring session will meet weekly after school for a total of two hours, followed by a quick debriefing called a rap session. The mentors that we are recruiting are leaders on and off their campus. They must be responsible, trustworthy, and they must have a 3.0 GPA. This link is the application required to apply for one of our volunteer mentoring positions. We look forward to having your young person's application soon. If you have any questions, please call 530.891.2891.

Applicant
If you have any questions, please call 530.891.2891 OR contact your school Impact Mentoring Coordinator. We look forward to reviewing your application soon! :)

1.Your campus mentoring program is recruiting for mentors for the upcoming 2021/2022 school year! Mentors must be good role models, responsible, honest, trustworthy and have a desire to help junior high school aged youth. They provide junior high students with needed support and guidance and have opportunities to be a positive example for their proteges. Mentors also benefit from being a part of this program. They increase public speaking skills and facilitation skills, get to meet new people and build positive relationships. Mentors must also commit to the following:
1. Attend all mentoring sessions (weekly)
2. Attend all rap (debrief) sessions (weekly)
3. Attend all mentoring trainings (summer 2021)
4. Come prepared to all sessions ready to lead and facilitate
5. Remain in good academic standing
6. Be a good role model to both peers and proteges

Please read through this application carefully, discuss the opportunity with your parents/caregivers and ensure you can fulfill all duties. Can you commit to all of the above?

Yes

2.What school will you be attending during the 2021/2022 school year?

3.What grade will you be in during the 2021/2022 school year (you must be 10th-12th grade to be a mentor)?

10th

11th

12th

4.What year will you graduate?

2021/2022 school year

2022/2023 school year

2023/2024 school year

2024/2025 school year

5.Please complete the following:

Name:

Birth date:

Address:

City + Zip:

Home phone:

Cell phone:

E-mail address:

Parent/caregiver name:

Parent/caregiver cell phone:

6.Please answer the following:

What are your favorite subjects in school?

What are some of your strengths?

What are some of your weaknesses?

What extra-curricular activities are you involved in?

What are your career goals?

What are your hobbies/interests?

8.What is your current GPA?

3.0-3.4

3.5 or higher

9.Please answer the following:

Why do you want to be a mentor?

Why do you think you would be a good mentor?

What do you see as the biggest issue facing junior high students?

10.Forms of Reference
We would love to have at least one reference on your behalf (two is even better). You can send the link below to anyone who might complete it on your behalf. You can also submit traditional (paper) letters of reference/recommendation. Please indicate below the name of the person/people you've sent the link to. Please use this link for your electronic letter of reference (if not submitting a paper copy):
https://www.surveymonkey.com/r/Mentoring-Reference-Form

Name + relationship:

Name + relationship

Thank you for completing this application! If you have any questions, please contact your Impact Mentoring staff member or call 530.891.2891.

Current Progress,

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