Charlotte Housing Authority Scholarship Fund Mentoring Application
Thank you for your request in participating as mentor to recipients of the Charlotte Housing Authority Scholarship Fund!

Our goal is to create a program that will encourage the development of meaningful relationship between each mentor and mentee. To participate, you need to go through a screening process.

First, we want to know more about you and your interest and skills so we can better match the interests of mentors and mentees. Please take the time to answer the brief list of questions below. Second, complete the application below; all information you provide will be kept confidential.
Email address *
Applicant's Name (First, Middle Initial, Last) *
Home Address (Street, City, State, Zip) *
Primary Email *
Secondary Email
Cell Phone Number *
Secondary Phone Number
Gender *
Place Of Employment /Job Title *
Business Address (Street, City, State, Zip Code) *
Business Phone Number *
Education (List College(s) Attended/Major/Degree Earned *
Religious Affiliation
Community and Civic Affiliation *
Interest, Skills, Hobbies *
Have you been convicted of a crime other than a minor traffic violation? *
If you answered yes to the above question, please explain
Personal References
To ensure the safety of the program participants, CHA Scholarship Fund will be checking personal references on every applicant. Please list two people who know you well and can attest to your to your character, skill, and dependability.
Reference #1 (Name/Relationship/Contact Info) *
Reference #2 (Name/Relationship/Contact Info) *
Why do you want to become a mentor with this program? *
Have you ever worked with youth? *
If yes, explain in what capacity you have worked with youth. (What was your role and was it through volunteer activities, your own children, etc.)
Do you have any medical, psychological, or social problem that might interfere with the performance of the duties of CHASF Mentor/Life Coach, or that might generally be considered inappropriate for working with young adults? *
Check the appropriate box below to serve as a mentor for the Charlotte Housing Authority Scholarship Fund *
I, (please insert your full name below) *
want to serve as a mentor for Charlotte Housing Authority Scholarship Fund. I understand that a third-party investigative agency may be called in to conduct background check on all volunteer applicants prior to their acceptance into the program. Any information obtained by the investigative agency conducting the background check will be used only in connection with the applicant's participation in Charlotte Housing Authority Scholarship Fund's Mentoring Program.

If accepted as a volunteer for Charlotte Housing Authority Scholarship Fund, I agree to adhere to the Program Guidelines outlined with Charlotte Housing Authority Scholarship Fund.
Signature (Electronically) and Date *
Never submit passwords through Google Forms.
This form was created inside of Charlotte Housing Authority Scholarship Fund. Report Abuse