Mentor Application
Name
Your answer
Phone Number
Your answer
Email Address
Your answer
City, State, Country
Your answer
Age
Your answer
Marital or Relationship Status (optional)
Your answer
Would you be able to mentor a mother who prefers to speak in Spanish?
Number of Children
Ages of Children
Your answer
Faith or religious affiliation (optional)
Your answer
Would you be interested in discussing your faith/spirituality with your mentee?
Not interested
Very Interested
Family situation and/or lifestyle (check all that apply)
When your kids are/were young, what is/was your working situation?
Please describe your education and work background (degrees, career field, training or certifications)
Your answer
Please select areas you feel you could provide support to a mentee
Required
Please describe your parenting style values/beliefs
(Attachment/BabyWise/Free-range/helicopter, views on breastfeeding, sleep training, or discipline, etc.)
Your answer
Is there anything else you would like to tell us about yourself?
Your answer
Are you able to commit to 30 minutes per week to connect with your mentee (via chat/video conference/Skype, etc)?
If you are unable to commit 30 minutes per week for 15 weeks, please consider applying again when you have more availability and are able to commit regularly scheduled time with your mentee.)
Please detail your availability (mornings/afternoons/evenings, weekdays/weekends, etc.)
Your answer
How did you hear about Mentoring 4 Moms?
Your answer
Were you referred by someone? If so please put their name here.
Your answer
By submitting this application I hereby release the the founders and all members of Mentoring 4 Moms from any and all liability of personal injury to me or members of my family and any loss or damage to my personal property by participation in the program. I understand that Mentoring 4 Moms is not a substitute for services or medical advice from a health or mental health professional.
Required
If you already have possible mentees in mind please send them the MENTEE application and tell us their name(s)
Your answer
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