Mentor Application
Please fill out this application to the best of your ability in order for us to determine the best match for you. Please note that this is not a guarantee of a match, but the information will be used in matching up mentors and mentees. Once your application has been processed, you will be contacted about eligibility to be a mentor and, if applicable, who you are matched with. Please contact Abbie Stuart at astuart@trmonline.org or 785-354-1744, ext. 348 with any questions.
First and Last Name: *
Your answer
Email: *
Your answer
Phone number: *
Your answer
Address: *
Your answer
Church: *
Please include the denomination if applicable.
Your answer
Age & Birthday: *
Your answer
Gender *
Current Occupation: *
If you are retired, between occupations, or unemployed, please put your most recent or your next occupation in the box below.
Your answer
Current Education *
If you are currently attending school, please list the name of your school, intended major/minor, and estimated graduation date. If you are not currently attending school, please put NA in the box.
Your answer
Family Information: *
Please include the names of your spouse (if applicable), children (if applicable), and grandchildren (if applicable).
Your answer
Please select all that apply: *
Please note that, while these items may be taken into consideration when determining eligibility to participate in the mentor program, these items by themselves will not be the deciding factor in eligibility to participate in the mentor program.
Required
Emergency Contact: *
Please list the name, email address, and primary and secondary phone of a person Doxazo, the Topeka Rescue Mission, your mentee, emergency personal, or another relevant party can call in case of an emergency.
Your answer
Reference #1 - Pastoral Staff Reference: *
Please list the name, email address, phone number, address, and capacity in which you know a member of a pastoral staff, including, but not limited to the senior pastor, elder board, youth pastor, worship pastor, or outreach pastor of your church.
Your answer
Reference #2 - Non-Familial Reference: *
Please list the name, email address, phone number, address, and capacity in which you know the person you are listing as a reference.
Your answer
Please share a brief biography: *
Please include things such as hometown, family make-up, important events, jobs, sports, hobbies, etc. Please include as many details as you are comfortable sharing in order for us to get the most accurate match possible.
Your answer
Please share your testimony: *
Please include as much detail as you are comfortable sharing in order for us to get the most accurate match possible.
Your answer
Please share what Jesus has been teaching you lately: *
Please include as much detail as you are comfortable sharing in order for us to get the most accurate match possible.
Your answer
Please share any past mentoring experience you have had: *
If you have never had any sort of mentoring experience, please put NA in the box.
Your answer
Why do you want to be a mentor? *
Your answer
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