Mentor Application
Being a mentor to a new parent is a very special honor. Early parenthood is a time of vulnerability and trepidation. Therefore, we screen our applicants thoroughly and only accept mentors of the highest quality into our program. Thank you for starting this process.
Your Name *
Your answer
Your Email *
Your answer
Your Address *
Your answer
Your Mobile Phone Number *
Your answer
How did you hear about us? *
Your answer
History
Employment History
Please list your most recent three employers, dates of employment, and reason for leaving.
Your answer
Do you currently work outside of the home? *
Current Position and Employer
If you work outside of the home, please list your current job title and the name of the company or organization for which you work.
Your answer
Do you speak a second language in addition to English? If so, which language do you speak?
Your answer
Residence History *
Have you lived in the Commonwealth of Pennsylvania for the last 10 consecutive years?
Residence History *
Please list your your residence history for the last 10 years, including the dates you have lived at each residence. Note: If you have lived at more than three addresses within the last 10 years, you only need to include the most recent three.
Your answer
Volunteer Experience
If you have volunteered before, please list those experiences below.
Your answer
References *
Please list three references. They may be any combination of the following: personal, work, volunteer. Be sure to include your reference's name, relationship, phone number and email address.
Your answer
Preferences
Briefly tell us about your experience in parenting and why you want to share that experience as a NurturePA Parent Mentor. What do you hope to gain from this experience? *
Your answer
What, if any, experiences do you have outside of parenting that relate to early childhood development, parent support, education, community outreach, counseling, etc.? *
Your answer
We support parents with a wide variety of experiences, histories, and levels of need (teen parents, drug/alcohol issues, single parenting, poverty, etc.). Are there any scenarios that you would feel highly uncomfortable/unfit supporting? Please explain.
Your answer
Do you consider yourself to have strong opinions about “hot button” parenting topics (vaccinations, co-sleeping, breastfeeding/bottle feeding, stay-at-home/working, etc.)? If so, do you feel that you would be able to effectively support parents who might not share your views? Please explain.
Your answer
Do you have consistent access to a computer and wifi? *
Note: Volunteer mentors text new moms through software that must be accessed from a computer or tablet.
Does your schedule allow you to commit about one hour each week to communicate effectively with ten enrolled parents? *
Do you feel you’ll be able to reply to texts from parents in a timely manner? *
Does your schedule allow you to commit to engaging in communication with your NurturePA, Inc. Manager on a regular basis? *
At NurturePA we believe strongly in providing ongoing feedback, education, and community building. We offer monthly Round Table Discussions and quarterly Learning Opportunities with our Community Partners. Will you make an effort to attend these events?” *
Security Clearances/Certifications
All NurturePA Applicants must have completed PA Act 33/34 Clearances (free for volunteers) and, if you've lived outside of PA in the past 10 years, FBI Fingerprinting ($21.35 for volunteers) as well. For faster consideration as a NurturePA Mentor, please begin this process as soon as possible.

Once you have a record of all of your clearances, please send all of the information at one time in PDF format to clearances@nurturepa.org with the subject line: [Applicant Name]'s Clearances.
- Act 34 (PA criminal history clearance certification)
- Act 151 (child abuse history clearance certification)
- Either Act 114 (FBI criminal history clearance certification) OR a signed volunteer disclosure statement

Do you have current (within 5 years) PA state criminal and child abuse clearances? *
Miscellaneous Information
If do not have your security clearances/certifications, are you willing to obtain them? *
Please visit http://nurturepa.org/?page_id=999 for more information.
Is there anything else related to your application that you would like to share with us?
Your answer
Are you able to make a one year commitment to mentoring new moms?
We prefer that mothers enrolled in the NurturePA program maintain the same mentor for at least the first year of their baby's life during that important and vulnerable time frame. A three year commitment from mentors to support mothers during their entire duration in the program is most desired.
All candidates are required to attend an in-person 3-hour orientation. Once the orientation has been attended, candidates will be given access to our online new mentor training module series to be completed prior to beginning as a mentor. Please indicate which of the following orientation dates will work for your schedule.
Note: Orientations are held in our meeting space near Mercy Hospital. More information will be shared once your application is approved.
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