MENTOR APPLICATION 

NAME _________________________________    Gender _______ 

Mailing address  ______________________________

                             ______________________________

Home phone_______________________ Pager/Cellular ____________________

Email_____________________________

Employer ___________________________

Please take the time to answer these questions, so that we can make the best match.

Hobbies/Interests _________________________________________________________

Have you ever worked with young people before? ________ yes  ________ no

If yes, what capacity? ___________________________________________

Have you previously mentored a student at J C S?________ no ________ yes        

If yes, who? ________________________________

If yes, would you like to mentor the same student? ________ yes ________ no

Why do you want to mentor a child at JCS? ____________________________________

Can you make a commitment to have contact with your mentee a minimum of every

other week? _________ yes _________ no

Is there anything else that you would like to about yourself or your interests that would

help us match you to a student? ____________________________________________

 ______________________________________________________________________

 Do you prefer a male or a female mentee? ______ boy _____ girl _____ either

A police background check is also required.

 WE WILL CONTACT YOU WITH THE NAME OF YOUR CHILD.