Mentor Application

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Mentor Application

Being a mentor to a mom of a newborn is a very special honor. Early parenthood is a time of vulnerability and trepidation. Therefore, we screen our applicants thoroughly and only accept mentors of the highest quality into our program. Thank you for starting this process.

Your Name *

Your Email *

Your Address *

Your Mobile Phone Number *

How did you hear about us? If referred by a friend or current mentor, please include her name. *

History

Employment History *

Please list your most recent three employers, dates of employment, and reason for leaving.

Do you currently work outside of the home? *

Yes

Current Position and Employer *

If you work outside of the home, please list your current job title and the name of the company or organization for which you work.

Do you speak a second language in addition to English? If so, which language do you speak? *

Residence History *

Have you lived in the Commonwealth of Pennsylvania for the last 10 consecutive years?

Yes

Residence History *

Please list your residence history for the last 10 years, including the dates you have lived at each residence. Note: If you have lived at more than three addresses within the last 10 years, you only need to include the most recent three.

Volunteer Experience *

If you have volunteered before, please list those experiences below.

References *

Please list three references. They may be any combination of the following: personal, work, volunteer. Be sure to include your reference's name, relationship, phone number and email address.

Preferences

Briefly tell us about your experience in parenting, including the age(s) of your child(ren) and why you want to share that experience as a Nurture® Program Parent Mentor. What do you hope to gain from this experience? *

What, if any, experiences do you have outside of parenting that relate to early childhood development, parent support, education, community outreach, counseling, etc.? *

Any mom who delivers in one of our partner hospitals has the opportunity to enroll in the Nurture® Program. Therefore, the moms you support will most likely have different backgrounds, histories and levels of need. This may include various family structures, a wide range of income levels, possible drug/alcohol issues, etc. Are there any scenarios that you would feel highly uncomfortable supporting? Please explain. *

Do you consider yourself to have strong opinions about “hot button” parenting topics (vaccinations, co-sleeping, breastfeeding/bottle feeding, stay-at-home/working, etc.)? If so, do you feel that you would be able to effectively support moms who might not share your views? Please explain. *

Do you have consistent access to a computer and wifi? *

Note: Volunteer mentors text moms of newborns through software that must be accessed from a computer or tablet.

Yes

Does your schedule allow you to commit about one to two hours each week to communicate effectively with ten to 15 enrolled moms? *

Yes

Do you feel you’ll be able to reply to texts from moms in a timely manner (within 24 hours)? *

Yes

Does your schedule allow you to commit to engaging in communication with your Nurture® Program supervisor on a regular basis? *

Yes

At NurturePA, we believe strongly in providing ongoing feedback, education, and community building. We offer monthly Round Table Discussions and quarterly Learning Opportunities with our Community Partners. Will you make an effort to participate in these events either in person or virtually when available? *

Yes

Miscellaneous Information

Is there anything else related to your application that you would like to share with us?

Are you able to make a one year commitment to mentoring moms of newborns? *

We prefer that moms enrolled in the Nurture® Program maintain the same mentor for at least the first year of their baby's life during that important and vulnerable time frame. A three year commitment from mentors to support moms during their entire duration in the program is most desired.

Yes

I'm not sure

All candidates are required to complete new mentor orientation and training which is offered on line. Please check below indicating you are willing to complete the on line training. *

I agree to complete the on line training.

Required

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