Mentor Application

Teen Mentor Application

Mentor Application

Would you like to change the life of a teen? Please fill out this form to get started.

Date:
Name:
Birthday:
Address:
City
State:
Zip Code:
Home Phone
Cell Phone:
Email Address
Emergency Contact:
Phone Number
Relationship to you:
Educational Background:
Employment Background:
How do you prefer to receive news from Teenlite Inc. regarding upcoming events and other important information?

Phone Call
Email
Both
What experience have you had working with youth?
What recreational activities do you participate in?
What other interest/ hobbies do you have?
Why are you interested in becoming a mentor?
Why do you think you would be a good mentor?
What age do you prefer to work with?
Do you speak another language other than English? If so: Which Language?
Teenlite Inc. requires the following information from all mentors. Thank you for your help providing the safest environment possible for teens. Do you use illegal Drugs?
*

yes
No
Are ther any Pending criminal Charges Against you?
*
Yes
No
Have you ever been convicted of a felony offense? Please note: A conviction may not necessarily disqualify you. Give offense, date, and jurisdiction.
*
Yes
No
Have you ever been charged with child neglect or Abuse? If so Please state thge date and jurisdiction.
Is there any fact or circumstance involving you or your background that could call into question your being entrusted with working with teens? If yes please Explain.
Please List 3 names, phone numbers and relationship of people Teenlite can contact who know you well and can attest to your character, skill and dependability. Please do not list a relative.
I understand that this is an application for and not a commitment or promise to volunteer. I certify that i have and will continue to provide information throughout the selection procress that is true to the best of my knowledge. I certify that i have and will answer all questions to the best of my ability and will not withhold any information that would affect my application for a volunteer position. I understand that information contained on my application will be verified, if necessary, by Teenlite Inc. contacting any person, organization that may have information concerning me. I release and agree to hold harmless from liability any person or organization who provides information. I understand that misrepresentations or omissions may be cause for my immediate rejection as an applicant for volunteer position as a mentor or my termination as a volunteer.