BOSS Impact Academy Mentor/Volunteer Interest Form

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Email *

Full Name *

Phone number *

Age *

Gender *

Are you interested in Mentoring or in serving in another volunteer capacity? *

Mentor ( Male mentors preferred; work directly with our young men)

Volunteer (i.e support us at events, conduct an activity or workshop with youth)

Mentor ( Female mentors preferred; work directly with our young women)

Program Operations Internship

Fundraiser and Development Internship

Youth Education and Scholarship Internship

Social Media and Marketing Internship

Mentor Recruitment and Community Outreach Intern

Other:

Have you served as a Mentor in the past? *

What is your availability? Check all that apply *

Monday Evenings (most important)

Tuesday Evenings

Wednesday Evenings

Thursday Evenings (most important)

Friday Evenings

Some Saturdays (about 1 a quarter, time varies)

Some Sundays (about 1 a quarter, time varies)

Required

What age group are you interested in mentoring?

Please Note: your selected age group(s) is not guaranteed. You will be placed where the need is.

Ages 8 - 9years old

Ages 10 - 11 years old

Ages 12 - 13 years old

Ages 14 and up

The main component our youth need is consistency!! Can you dedicate yourself for the periods below? *

August 2026 - June 2027

Other:

Why are you interested in becoming a Mentor/Volunteer with our program? *

Have you ever been convicted of, or entered a plea of guilty, no contest, or had a withheld judgment to a felony?

Yes

If Yes, Please explain or put N/A

Do you have copies of Child Abuse Clearances and/or Criminal History Record Checks within the past 6 months? *

Yes

Do you have a driver's license? *

Yes

How did you find out us? *

Questions? Comments? Concerns?

A copy of your responses will be emailed to the address you provided.

Submit

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