CK Teen Mentor Program Application 2017-2018
Thank you for your interest in becoming a teen mentor for CK Schools.

The mentor application is designed to make sure you understand the commitment and maturity you must demonstrate for the entire school year.

As a teen mentor you will be meeting once a week with an elementary student in grades K-5. Teen mentors may be asked to mentor at any elementary school in the district. Your school assignment will be made with elementary children’s needs in mind. Many mentors have returned to the elementary school they attended. Your preference for elementary school will be honored when possible.

Most teen mentors schedule their weekly mentoring time at the end of the school day and miss all or at least a portion of their sixth period class. Please consider your class schedule when applying for mentoring.

To become a Teen Mentor, you must:
>Be a 10th-12th grade student at CKHS, OHS, or KSS
>Maintain a 2.8 GPA.
>Attend school regularly.
>Agree to adhere to all CK Schools Mentoring Program policies and procedures.
>Agree to participate at least one school year.
>Commit to spending one hour each week with your mentee.
>Attend a mandatory mentor training
>Attend additional on-site training with your elementary coordinator.
>Be willing to talk with the staff and get all paperwork done on time.

Basic Demographic Information
First Name *
Your answer
Last Name *
Your answer
Date of Birth *
Gender *
Street Address *
Your answer
City *
Your answer
Zip Code *
Your answer
Ethnicity *
Primary phone number (please remember to include area code) *
Your answer
What school do you attend? *
Grade Point Average
Your answer
What days of the week are you available to volunteer? Check all that apply. *
Interest Survey
What qualities should a good mentor possess? *
Your answer
What qualities do you have that make you a good friend? *
Your answer
Describe experiences you have working with younger children. *
Your answer
What grade level would you like to work with? *
Please indicate the types of things you enjoy doing. Check all that apply. *
Do you speak/use a language other than English proficiently? *
If you do speak another language(s) proficiently, please list the language(s).
Your answer
Do you prefer to work with quiet, shy, and/or introverted students? *
Do you prefer to work with outgoing, social, and/or extroverted students? *
Would you be interested in working with student who has a disability? *
Would you prefer to work with a student from a particular racial/ethnic/cultural group? *
Please indicate the school(s) in which you prefer to work. Check all that apply. *
What other information would you like to share to help us better match you with a mentee? (For example: Do you have pets? Brothers/sisters? Unique personal attributes?)
Your answer
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