CHAMP Mentor Application 2021-2022
Please complete this form if you are interested in becoming a Freedom School CHAMP Mentor. Please read these directions in full. Filling out this application does not guarantee you a spot; the leadership team will email you if you are accepted.

CHAMP is a commitment for every Monday afternoon from 3:00 pm until 5:30 pm at Dilworth Elementary - Latta Campus. 2 Mondays will involve riding the church vans home with the students, so you will need to be available until 6:15 pm on those days. You can sign-up for the van date of your choice at training.

If selected to be a mentor, you must attend the CHAMP training meeting on September 13th at 4:00 pm at MPUMC (room TBD).

Thank you for your interest in CHAMP! We are so excited for a great year!
Name (first, last) *
Phone Number *
Personal Email Address *
Grade Level (2021-2022) *
When are you available? *
Are you an MPUMC member? *
Why are you interested in the CHAMP Program? *
What would make you a good Mentor? *
I acknowledge Dilworth CHAMP is a commitment for every Monday afternoon from 3:00pm until 5:30 pm at Dilworth Elementary - Latta Campus. I understand I have made a promise to be present and attentive each week. I acknowledge I must attend a training prior to the first CHAMP Monday. *
I acknowledge that homework, schoolwork, midterms/finals, or any other extracurricular activities do NOT equal an excused absence. 2 unexcused absences from CHAMP will equal a removal from the program. Also, if I need to miss a Monday, I know who to contact. *
I acknowledge that it is required I choose 2 Mondays to ride the church vans home with the students, and I will need to be available until 6:15pm on those days. Also, I know where to sign up to help. *
I agree to present proof of vaccination or a weekly negative COVID-19 test prior to entering the church building and/or Dilworth Elementary. *
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy