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
First Name *
Your answer
Last Name *
Your answer
Date of Birth *
You must be at least 21 years of age in order to be considered for the Mentor Program in CK Schools.
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Gender *
Street Address *
Your answer
City *
Your answer
Zip Code *
Your answer
Ethnicity *
Email Address *
Your answer
Primary phone number (please remember to include area code) *
Your answer
Secondary phone number (please remember to include area code)
Your answer
Employment
Name of Employer
Your answer
Work Phone Number (please include area code)
Your answer
May we call you at work using this phone number?
What days of the week are you available to volunteer? Check all that apply. *
Required
Interest Survey
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. *
Required
Please indicate the types of things you enjoy doing. Check all that apply. *
Required
What qualities should a good mentor possess? *
Your answer
What qualities do you have that make you a good friend? *
Your answer
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