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"“Youth Mentored for a Better Future “" Mentor Program
MENTOR ASSESSMENT, RULES, AND CONSENT FORM
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* Indicates required question
Email
*
Your email
First name
*
Your answer
Last name
*
Your answer
How old are you
*
Your answer
Desired age group to be paired with
Middle school (Ages 9-13)
High School (Ages 14-18)
College (Ages 19-23)
No preference
Clear selection
Gender
*
Male
Female
Other:
Are you married or single?
*
Your answer
Do you have any children? If so, how many?
*
Your answer
What is your profession?
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Your answer
Mentees are looking for guidance and support concerning their academics and future career. Based on this, what are you looking to bring to your mentee?
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Your answer
I understand that I will be assigned to a mentee with the same gender as me.
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Yes
I understand that I will have to do a soft background check and am willing to pay for the $30 expense
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Yes
No
I understand that I will have to sign a code of ethics statement.
*
Yes
I did receive the handbook acknowledgment form.
*
Yes
No
I understand that all of my interactions with my mentee are private and I am required to keep it between the YBF team and the family.
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Yes
I understand that I am required to sign a confidentiality agreement.
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Yes
Do you have any previous experience as a mentor?
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Yes
No
If yes, how long were you a mentor?
Your answer
Describe your past experience as a mentor if any?
Your answer
I understand that being a part of YBF's program will require my commitment for a minimum of 10 weeks
*
Yes
Do you have any foreseeable conflicts?
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Yes
No
Other:
If previously answered yes, please explain
Your answer
I understand that I have to be an example to my mentee and profanity is strongly forbidden.
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Yes
I understand that I entirely taking responsibilities for anything neglectful on my part that doesn't go with YBF's policies and procedures
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Yes
Meeting Options
*
Virtual
In-Person
No Preference
Required
I 100% indemnify and assume all liabilities resulting from failing to follow YBF's policies and procedures.
*
Yes
Send me a copy of my responses.
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