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City Rocks Mentor Application
Please submit the following application by January 30, 2024

MENTOR REQUIREMENTS AND ELIGIBILITY:

1. MUST BE A MEMBER OF THE CLIFFS / MOVEMENT GOWANUS
2. BE AT LEAST 23 YEARS OLD
3. HAVE A SOCIAL SECURITY #
4. SUBMIT AN APPLICATION
5. ATTEND A 2.5 HOUR TRAINING (VIRTUAL OR IN-PERSON)
6. COMPLETE A FINGERPRINT BACKGROUND CHECK (one time fee of $60)
7. COMMIT TO AT LEAST 4 HOURS PER MONTH FOR A FULL SCHOOL YEAR.  

The Program Director will be sending you information on all of the above. If you have any questions about the application or the City Rocks Mentoring Program please contact the Program Director Dave Owen at dave@owenconsulting.com or 646-242-6592
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Name
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Year of Birth
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Gender
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Address
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Cell Phone *
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Name of Employer  
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Brief Description of your Job (Role, responsibility, skills, etc.)
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Volunteer Information
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1. What do you feel are the strengths (bi-lingual, academic skills, previous relevant volunteer / education/ working with young people / experience. etc.) you bring to this program?
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2. Write a brief statement on why you have chosen to participate in the mentoring program.
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 3. Please check the box next to the two statements below:
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I understand that I will be required to participate and complete a three hour mentor training and submit to a background check
I understand that I will be required to spend at least 4 hours per month with my mentee between October and June of the current school year.
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4. Within the past 10 years have you ever been convicted of any felony or misdemeanor classified as an offense against a person or family, or an offense of public indecency or a violation involving a state/federally controlled substance?
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Yes
No
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5. Are you under current indictment or has a district/county attorney accepted an official complaint for any of the offenses in question #4?
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No
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6. If the answer is Yes to questions 4 or 5 please explain below:
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7. Educational Background:
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Some High School
Graduate/professional school
College graduate
High School Graduate
Some college
Military
Vocational School
Other
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8. References - please list three- one family member, one personal friend and one work reference (name and contact info)
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In submitting this application to be a mentor volunteer, I understand that City Rocks routinely performs criminal background checks of all volunteers for the position of mentor for which I'm applying. This check may be done for me if I sign below. If I fail to sign, it may be grounds for rejecting me as a mentor. I certify to the best of my ability that the information provided on this application is true and accurate. I also understand that misinformation knowingly provided here, and on subsequent mentor application forms is grounds for dismissal. (sign/type name and date)
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City Rocks Supplemental Matching Form
Please give us as much background information on you in this section as possible - we use this information to help match you with a mentee who has similar background and interests.
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List some of your hobbies and interests, and extracurricular activities
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What kind of music do you like?
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What kind of sports do you like to watch and / or play?
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What are some of your favorite TV shows?
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Do you speak another language?
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What are some of your favorite Movies?
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What are some of your favorite books?
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What are some of your favorite foods?
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What were some of your favorite subjects in school?
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What is something you'd like to get out of your mentoring experience?
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What else is there about your background that you'd like to tell us that could help us in matching you with your mentee?
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What days of the week are your preferred days for meeting with your mentee (after school on weekdays or on weekends or either)?
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Year of Birth
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Gender
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Address
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Cell Phone *
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Name of Employer  
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Brief Description of your Job (Role, responsibility, skills, etc.)
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Volunteer Information
1. What do you feel are the strengths (bi-lingual, academic skills, previous relevant volunteer / education/ working with young people / experience. etc.) you bring to this program?
No responses yet for this question.
2. Write a brief statement on why you have chosen to participate in the mentoring program.
No responses yet for this question.
 3. Please check the box next to the two statements below:
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No responses yet for this question.
4. Within the past 10 years have you ever been convicted of any felony or misdemeanor classified as an offense against a person or family, or an offense of public indecency or a violation involving a state/federally controlled substance?
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No responses yet for this question.
5. Are you under current indictment or has a district/county attorney accepted an official complaint for any of the offenses in question #4?
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No responses yet for this question.
6. If the answer is Yes to questions 4 or 5 please explain below:
No responses yet for this question.
7. Educational Background:
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No responses yet for this question.
8. References - please list three- one family member, one personal friend and one work reference (name and contact info)
No responses yet for this question.
In submitting this application to be a mentor volunteer, I understand that City Rocks routinely performs criminal background checks of all volunteers for the position of mentor for which I'm applying. This check may be done for me if I sign below. If I fail to sign, it may be grounds for rejecting me as a mentor. I certify to the best of my ability that the information provided on this application is true and accurate. I also understand that misinformation knowingly provided here, and on subsequent mentor application forms is grounds for dismissal. (sign/type name and date)
No responses yet for this question.
City Rocks Supplemental Matching Form
List some of your hobbies and interests, and extracurricular activities
No responses yet for this question.
What kind of music do you like?
No responses yet for this question.
What kind of sports do you like to watch and / or play?
No responses yet for this question.
What are some of your favorite TV shows?
No responses yet for this question.
Do you speak another language?
No responses yet for this question.
What are some of your favorite Movies?
No responses yet for this question.
What are some of your favorite books?
No responses yet for this question.
What are some of your favorite foods?
No responses yet for this question.
What were some of your favorite subjects in school?
No responses yet for this question.
What is something you'd like to get out of your mentoring experience?
No responses yet for this question.
What else is there about your background that you'd like to tell us that could help us in matching you with your mentee?
No responses yet for this question.
What days of the week are your preferred days for meeting with your mentee (after school on weekdays or on weekends or either)?
Copy chart
No responses yet for this question.
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