STUDENT-MENTOR EMPLOYMENT APPLICATION

Grounding Waters and Constructing Careers Mentoring Programs

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* 1. Contact Information

Name

Field of study

Current GPA

Home Phone #

Work Phone #

E-Mail Address

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* 2. What is your gender?

Female

Male

Non-gender conforming

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* 3. What is your age?

17 or younger

18-20

21-29

30-39

40-49

50-59

60 or older

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* 4. Please describe your race/ethnicity.

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* 5. Do you own or have regular access to a vehicle?

Yes

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* 6. Which of the following fields align with your career interests or hobbies? check all that apply

Green Building

Environmental Science

Fisheries and Wildlife/Biology

Natural Resources

Civil Engineering

Construction/Trades (e.g., carpentry, electrician, masonry, HVAC, etc.)

Landscape Architecture

Water Resources

Urban Forestry

Ecology

Social Justice

Environmental Justice

None of these

Other (please specify)

EXPERIENCE

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* 7. How does the concept of mentorship translate to you personally? Give examples of times in your life where you have been mentored to, as well as any experience you have in mentoring others.

SPECIAL SKILLS AND QUALIFICATIONS

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* 8. Summarize special skills, qualifications, and your strongest attributes that you feel would make you an effective mentor for youth of color.

PHILOSOPHY

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* 9. “Culture For Service, Service For Humanity"… In your own words, what does this phrase mean to you?

REFERENCES

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* 10. Please list three references, non-related, whom you feel know you well enough to speak to your character.

Reference 1 (Name, Phone, email)

Reference 2 (Name, Phone, email)

Reference 3 (Name, Phone, email)

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* 11. Are you available to attend a mentor training on October 14th, 15th, and 21st of 2017?

Yes

AGREEMENT

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* 12. By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as a student-mentor, any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal.

Yes, I understand

Thank you for your interest in being a mentor. If you have any questions, please contact Jason Stroman: EMAIL: jason@theblueprintfoundation.org PH: (503) 901-6845.