2019-2020 CCDI Mentor Interest Application
Please fill out the top portion of required information. The bottom half is recommended, but not required.
Email *
REQUIRED INFORMATION
First & Last Name *
Place of Employment *
Job Title *
Date of Birth *
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Cell Phone Number *
Mailing Address *
MENTOR BACKGROUND QUESTIONS (Optional)
Please feel free to complete the following questions at your convenience. You do not have to answer every question.
Gender
Ethnicity
Are you bilingual? Indicate Languages/ Written/ Spoken
What are your interests, hobbies, activities you do for fun?
Please give brief overview of your career background, what your areas of expertise are, and personal strengthens you could provide a mentee.
BECOMING A CCDI MENTOR (Required)
Please briefly explain why you would like to become a mentor for CCDI. *
Have you ever worked with children, young adults, or previously been a mentor?
Clear selection
Which age group would you prefer for a mentee? (check all that apply)
What mentor or coach pathway are you most interested in? (check all that apply) *
Required
MENTOR REQUIREMENTS & EXPECTATIONS
Attend an initial mentor training session and other mentor-mentee events after being matched.
Clear selection
Have your name ran through a criminal record check. (A MO/IL background check application will be emailed to you) *
Commit to trying to meet with your mentee once a month and/or staying in communication with them on a regular basis for a minimum of one year.
Clear selection
Assist with transportation for your mentee to attend CCDI events, specifically Saturday Academy sessions. (Not required, but appreciated)
Clear selection
Valid driver's license and insurance. If selected, you will be asked to provide a copy of each.
Clear selection
FEEDBACK (Optional)
Please check out our website www.ccdi.org and on our social media pages @ccdicommunity
How did you hear about the CCDI program?
Additional Comments or Questions?
Thank you so much for expressing interest in becoming a CCDI mentor! We will be in touch with you soon!
Please contact Rachel Boemer at RachelBoemer@ccdi.org for immediate questions or Mentorship Committee Chairs Dan Lester at LesterD@claycorp.com or Branyea Jones at JonesBr@claycorp.com
A copy of your responses will be emailed to the address you provided.
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