Become a Mentor Application

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There is more than one way to join the movement!
The steps to become a mentor
1.Complete this written application.
2. Consent to background screening, which includes: (a) state and federal criminal background
checks, (b) search of state and federal sex offender registries.
3. Provide two personal references and two professional references.
4. Copy of driver’s license or state issued identification.
5. Complete a personal interview.

Name *

Email Address *

Address

Phone Number *

Are you at least 21 years of age? *

Yes

Are you willing to attend a training course about STEP Movement's policies and procedures governing its youth intiatives and to keep current on updated policies? *

Yes

Have you ever been charged with, or convicted of any crime, including anymisdemeanor or felony? If so, check “Yes” and provide details below.For each instance, provide the following information: (a) the relevantcharges; (b) relevant dates; (c) identify the court(s) in which anyproceedings were held; (d) supply the disposition related to all charges (e.g.,acquittal; conviction; no contest; charges currently pending, etc.); and (e) list thepunishment that was issued related to any convictions. *

Yes

Have you ever been investigated by state or federal authorities for child abuseor neglect? If so, provide details below, including (a) reason for investigation;(b) relevant dates; (c) relationship to child/children involved; (d) the agency oragencies that conducted the investigation; (e) the court(s) in which anyproceedings were held; (f) results of investigation; (g) any punishment or otherrequirements imposed by the relevant authorities. *

Yes

Have you ever been terminated from a paid or volunteer position? If so,explain below. *

Yes

Other:

Other than the above, is there any fact or circumstance involving you or yourbackground that would call into question your being entrusted with thesupervision, guidance or care of young people? *

Yes

Provide explanations below (attach additional sheets as necessary and reference the applicable question number).

I hereby authorize the STEP Movement, LLC to conduct background screening related to my application for a volunteer position The background screening procedures include the review of local, state, and nationwide criminal background checks, search of state and federal sex offender and child abuse registries and other databases and communication with personal and professional references. *

Yes

I authorize STEP Movement, LLC to obtain information necessary to complete its background screeningprocedures to be obtained from any relevant source, including federal, state, and local law enforcementagencies; searchable online official registries and databases; and individuals I have identified as personaland professional references. *

Yes

I also authorize STEP Movement, LLC to complete background screening on me on a triennial basis (every 3years), for as long as I remain a volunteer, if I am accepted as a volunteer and serve for more than one year. I further agree to complete all requirements to facilitate completion of such backgroundscreening. *

Yes

I also agree that once accepted as a volunteer, I must notify STEP Movement immediately if I am the subject of any pending charges and/or convicted of an offense at any time after submitting this applicationor being cleared as a volunteer. I also further acknowledge that a volunteer with pending charges relatingto abuse, neglect, a drug related offense, any crime with the involvement of youth, termination from a paidor volunteer position related to misconduct with a youth, any crime involving violence or recent history ofsubstance abuse, will be terminated as a volunteer *

Yes

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