Mentor application
Thank you for your interest in becoming a mentor with Kids On The Rise. Please complete the following application. You will be contacted shortly with information regarding the background check and training.
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Name *
First and last name
Email *
Preferred Phone number *
Street Address *
City *
State *
Zip Code *
Occupation (current and/or former) *
Spouse name or other adults in your household *
Mentor Emergency Contact
Emergency Contact Phone #
Relationship to Mentor
License Plate Number *
A copy of your current driver's license and insurance card will be kept in your file.
Personal References *
Please include contact information (phone and email) for three personal or business references whom we can contact regarding your application.
School Preference (s) *
Please select all schools from which you would prefer to mentor a student.
Required
I would work best with children/youth in the following grades: *
Please select all that apply
Required
Please share with us the experience and skills you have for mentoring children and youth as well as some hobbies and interests that you might like to share with a child. *
I certify that the information supplied on this application is correct and accurate to the best of my knowledge. In addition, I give permission for Kids On The Rise to contact my references and conduct a criminal background check. *
Please type your name below as your agreement to this statement.
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