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)
Your answer
Home Address (Street, City, State, Zip)
Your answer
Primary Email
Your answer
Secondary Email
Your answer
Cell Phone Number
Your answer
Secondary Phone Number
Your answer
Gender
Required
Place Of Employment /Job Title
Your answer
Business Address (Street, City, State, Zip Code)
Your answer
Business Phone Number
Your answer
Education (List College(s) Attended/Major/Degree Earned
Your answer
Religious Affiliation
Your answer
Community and Civic Affiliation
Your answer
Interest, Skills, Hobbies
Your answer
Have you been convicted of a crime other than a minor traffic violation?
If you answered yes to the above question, please explain
Your answer
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)
Your answer
Reference #2 (Name/Relationship/Contact Info)
Your answer
Why do you want to become a mentor with this program?
Your answer
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.)
Your answer
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)
Your answer
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
Your answer
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