Mentor Application

First name

Last name

Phone

Birthday

1. What motivates you to become a mentor with our organization?

2. Have you had any previous experience as a mentor or in a similar role? If so, please describe.

3. What's your current occupation?

4. How do you approach building trust and rapport with a mentee?

5. How would you motivate and encourage your mentee in achieving their goals?

6. How would you handle providing constructive feedback and guidance to your mentee?

7. How would you handle conflicts or disagreements that may arise in a mentoring relationship?

8. Are you willing and able to commit to one in person visit and one phone/virtual visit per month with your mentee?

Yes

9. What important qualities or characteristics do you possess as mentor?

10. Do you have any specific expectations or requirements for the mentee you would be paired with?

11. Are you willing to undergo any training or orientation sessions provided by the organization to enhance your mentoring skills?

Yes

12. Are there any potential conflicts of interest or commitments that may affect your ability to fulfill your role as a mentor?

14. If currently in school, where do you attend and what's your anticipated graduation date?

15. Do you have a vehicle and valid insurance coverage on the vehicle?

16. Do you have a valid drivers license?

Yes

17. Would you be willing to consent to a background check?

Yes

18. What are your hobbies and interest?

19. Is there any information you would like to share in considering your application?

20. Please provide name, phone and email of two references who can speak to your qualifications and character.

Have you ever been convicted (or are currently out on bail or out on your own recognizance pending trial) of a felony, or misdemeanor other than a minor traffic violation?

Yes

Release Agreement*

I hereby consent to participate in programs with Team Hand in Hand.

I release Team Hand in Hand, its staff, and volunteers from any liability for any injury, loss, or damage that may arise from my participation in its programs. I acknowledge that my participation is voluntary and agree to abide by the program's guidelines and expectations.

I consent to participate in programs in person and via virtual platforms such as Zoom, WebEx, Video calls, Teams and telephone.

I release Team Hand in Hand, its staff, and volunteers from any liability for any injury, loss, or damage that may arise from my participation in its program.

I hereby grant permission to Team Hand in Hand to take and use photographs and/or video recordings of me in connection with its programs. These images and recordings may be used for promotional materials, publications, social media, and the organization's website. I waive the right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising from or related to the use of these images or recordings. I also release its employees and any third parties involved in the creation or publication of materials.

Authorization

Agree

Disagree

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