Mentoring Intake Form

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Together Chicago and our partners are recruiting mentors to support our school based mentoring programs. We are tasked to support students who have uniquely experienced Adverse Childhood Experiences and can use social, emotional, and academic support. When choosing a community please note that at North Lawndale you will be paired with a high school student and at our South Side schools you will be paired with an elementary school student.

Upon completion of this form, you will be contacted by a team member who will offer further insights on the particulars of our mentoring partnership in the community you selected. We will also share future mentoring training, background check, and onboarding details.

Usually, we are asking for mentors to offer 2 hours of mentoring check-in support, during the students school day and at their school. When the relationship is established at school, we then connect mentors to families in an attempt to expand mentoring options to out of school mentoring as well.

Date *

YYYY

Name (First, Last) *

Email *

Organization *

Phone Number *

Community *

North Lawndale

Chatham

Bronzeville (immediate need of 15 men)

South Shore (immediate need of 15 men)

Which of the ways will you be able to support? *

Positive Reinforcement: Making students aware of their positive actions and encouraging them to continue to do so

Parent Involvement: Engaging the parent in their students life.

Ongoing Monitoring: Check in with students at school and outside of home.

Case Management Assistance: Managing the students engagement in the program.

Relationship Building: Building a strong relationship with student that can impact students other relationships

Applied Therapeutic Learning: Making student aware of therapeutic habits in everyday situations.

Community Resources: Providing student with resources in the community. (Jobs, sports, recreational activities, etc.)

Others

Required

How frequently can you mentor students? (we are seeking at least weekly school based mentoring checkins)

What are your preferred times to visit the school for 30-60 minute weekly mentoring sessions? [clarify that there will also be an option for checkins outside of school once the school based connections are established]

How many more people from your org might be able to mentor during the school day? (select one 0, 1-10, 10-20, 20+)

1-10

10-20

20+

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