Youth Mentor Information Form

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Email *

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First Name *

Last Name *

Home Phone + Cell Phone *

Address

I am interested in

3 Month Mentor - Meets Every 2 Weeks for 1 Hour with a New American

6 Month Mentor - Meets Weekly for 1 Hour with a New American

Other:

Birth Date

YYYY

Family Members (include names and ages)

Occupation

Places lived/travelled

Languages Spoken

Interests/Hobbies

Able to help with the following: (select as many as apply)

English language practice

Mentoring

Driving practice

Tutoring/homework

Transportation

Computer skills

Other:

Is there a particular group, culture, or language that you are most interested in learning about? Why?

What type of New American neighbors are you most eager to work with?

Family

Children

Young Adult

Elderly

Couple

No preference

Background Check: Your mentor application will be complete once you have completed our online background check and we have received its results. Because refugee and immigrant families are a vulnerable population, we require that all volunteers and mentors who will be meeting one-on-one with families complete a criminal background check through Coeus Global, at the mentor's cost. If you cannot afford the cost of the background check, please let us know. The link to complete the background check is here: http://www.coeusglobal.com/council_nd_bismarckglobalneighbors

I have completed the online background check

I will complete the online background check after completing my sign-up

I request help paying for the cost of the background check

Other:

Clear selection

By agreeing below, I acknowledge that Bismarck Global Neighbors may use the North Dakota Public Records database to check my driving record. The results of the check will determine whether I may or may not drive for Bismarck Global Neighbors and my New American neighbor(s).1. Volunteers who operate a motor vehicle for their volunteer experience must present and maintain proof of insurance, a valid driver’s license and an acceptable driving record as determined by Bismarck Global Neighbors.2. Guidelines: No alcohol or drug-related driving violations in the last five years; Have a valid U.S. driver’s license; Have no more than one speeding violation in the last three years; Have no other moving violations in the last three years; Have the appropriate type license, as required by law.3. Checks may occur at random times throughout my volunteering.

Agree

Decline--By declining the driver's record check, I agree that I will not drive my mentee partner(s) or their family members

Clear selection

Send me a copy of my responses.

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