CK Schools Adult Mentor Program Application
Adult mentors must:
Be 21 or older
Have reliable transportation
Have no criminal record for the past five years
Have no history of crimes against children
Commit to working with a student for an hour a week throughout one school year during regular school hours
Basic Demographic Information
Date of Birth
You must be at least 21 years of age in order to be considered for the Mentor Program in CK Schools.
American Indian or Alaska Native
Black or African-American
Native Hawaiian or Pacific Islander
Primary phone number (please remember to include area code)
Secondary phone number (please remember to include area code)
Name of Employer
Work Phone Number (please include area code)
May we call you at work using this phone number?
No - please use my primary phone number.
What days of the week are you available to volunteer? 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).
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.
Clear Creek Elementary
Cougar Valley Elementary
Esquire Hills Elementary
Green Mountain Elementary
Hawk Elementary at Jackson Park
Silver Ridge Elementary
Central Kitsap Middle
Olympic High School
Barker Creek Community School
Please indicate the types of things you enjoy doing. Check all that apply.
Arts and crafts
Attending the theater or plays
Board and/or card games
Computers (e.g., programming)
Doing boxed puzzles
Going to the zoo or museum
Listening to music
Playing a musical instrument
Riding a bike
Riding a horse
What qualities should a good mentor possess?
What qualities do you have that make you a good friend?
Never submit passwords through Google Forms.
This form was created inside of Central Kitsap School District.
Terms of Service