The Mentoring Application

We are excited about your interest in mentoring. All of the Mentoring Programs will service youth ages 13-24 from a variety of backgrounds and settings. You can choose the mentoring program that connects best to your desire to mentor. Please review the following requirements before completing the application:
 Mentors must be at least 21 years of age and male.
 Willing to undergo a background check.
 Attend a mentor training class.
 Should be able to dedicate the program's specified hours per month to mentoring.

The mission and goals include improving academic achievement, self-esteem, social competence, and avoidance of high-risk behavior by providing a relationship with a caring adult who works to help them achieve their full potential.

Question Title

1. Full Name:

Question Title

2. Date of Birth

Date

Question Title

3. Gender

Question Title

4. City:

Question Title

5. Email:

Question Title

6. Preferred Contact Method

Question Title

7. Phone Number

Question Title

8. Job Title

Question Title

9. Education Completed

Question Title

10. What inspires you to become a mentor?

Question Title

11. What mentoring program are you interested in?

Question Title

12. Mentors may connect with their mentees in various and creative ways. Do you have the technology available to engage in e-mentoring? 

Question Title

13. Are you willing to allow the Mentoring department to conduct a background check on you, including fingerprints?

Question Title

14. I agree to participate in the mentoring program. I understand
that my mentee will meet with me monthly for program-specific hours. I also agree to contact
the Program Manager if there should be a problem or if I am unable to attend an activity and/or if I can’t
meet at our specified time. I agree to contact program staff immediately if any issues or concerns arise.

Question Title

15. I understand the need to maintain confidentiality regarding information that I might gain about students,
families, and staff as I volunteer in the schools. I also understand that I am not to discuss individual
student progress or behavior with anyone other than school personnel. I understand that if I violate school
confidentiality rules, I may be asked to terminate my volunteer service.

Question Title

16. If I am selected to be a mentor I understand that my commitment involves spending a regularly scheduled
time weekly at the assigned school with my mentee throughout one school year. As part of my participation in this program, I will communicate with the Mentoring program personnel on a regular basis.

Question Title

17. I understand that pursuant to Section 22.0835 of the Texas Education Code, as well as program requirements within the Mentoring Program, has requirements to conduct a criminal history review and reserves the right to receive and review any records maintained by any law enforcement agency.

T