Mentor Application
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First Name *
Last Name *
Street Address *
City *
Zip *
Email address *
Phone Number *
Date of Birth *
Current Employer & Job Title *
Race *
Marital Status *
Number of Children
Please list the other individuals (including minors) that are part of your household and their date of birth (adults over 18 may be subject to a background check). *
Emergency Contact Name *
Emergency Contact Number *
Emergency Contact Relationship *
Do you have any allergies? *
Can you commit for at least 1 calendar year (2 years preferred)? *
Can you converse in Spanish? *
Have you ever been charged with or convicted of a felony? *
Have you ever been charged with or convicted of a misdemeanor? *
Have you been cited for a traffic violation within the last two years? *
How did you learn about SpringSpirit? *
Do you have any volunteer experience? If so, please list where and give a brief description of your role/responsibilities. *
Please explain why you would like to mentor a child from SpringSpirit. *
Do you attend church? *
If so, where do you typically attend?
Tell us a bit about your spiritual journey or what God has done in your life. *
Reference 1 Name *
Reference 1 Relationship *
Reference 1 Phone Number *
Reference 1 Email Address *
Reference 2 Name *
Reference 2 Relationship *
Reference 2 Number *
Reference 2 Email Address *
Electronic SIGNATURE of applicant: By signing below, I certify that all information given on this application is true and complete to the best of my knowledge. I know that by completing this application, I am not automatically accepted as a mentor for a child. *
ELECTRONIC SIGNATURE of applicant: I certify that I am currently maintaining Motor Vehicle Liability Insurance and carry a minimum of $100,000 per person, $300,000 per accident and $100,000 property damage or $300,000 combined single limit.  In the event that such insurance is terminated or canceled for any reason, I agree to promptly notify SpringSpirit.  I also agree not to operate a vehicle in connection with my child I am matched with until my insurance is reinstated.I agree that my insurance will be the sole and primary insurance coverage in the event of an accident while transporting my SpringSpirit mentee.  I agree to operate the vehicle in as safe and legal manner as possible while transporting my SpringSpirit mentee.
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