Drive-To-Thrive Mentoring Program Application
Thank you for your interest in becoming a mentor with the DRIVE TO THRIVE mentoring program. It is a great way to
make a difference in a young person’s life. This application is designed to provide information to help us match you
with the most appropriate child and your answers will be kept confidential. For security & safety purposes, all
mentor applicants will need to have fingerprints or background checks completed and cleared before
being matched with a youth. If you have any questions, please contact the Program Director.
Please mail, fax, or email your completed application and a copy of your driver’s license and
current auto insurance to:

Fateca Grant
Drive To Thrive Mentoring Program
301 Katherine Drive
Vicksburg, MS 39180
601-529-6794
infor@drivetothrivementoringprogram.org

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Name *
First and last name
Email *
Phone number *
ADDRESS *
Do you have any felony convictions or misdemeanors? IF YES, PLEASE EXPLAIN.
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Have you ever abused or molested a child?
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Do you have a clean driving record? YES NO If no, explain
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Why do you want to become a Mentor?
Would you be a positive role model to a child? What qualities do you have that will help mentor a child?
Do you have any experience working with, volunteering, or spending time with youth? If yes, explain:
Who was a mentor for you as a child? What qualities did they have that helped you?
Please describe your relationship with a best friend and/or significant other?
What are some of your interests & hobbies (things you would like to do with your mentee)?
Do you have a preference as to the age, race/ethnicity, gender, sexual orientation, special needs, religious, beliefs, political affiliation, socioeconomic background, or geographic location of the youth you’d work with?
2 Personal References: The following information is required of all applicants. PERSONAL REFERENCES NAME, PHONE, E-MAIL, RELATIONSHIP TO YOU? HOW LONG HAVE YOU KNOWN THIS PERSON?
1 Professional Reference: The following information is required of all applicants. PROFESSIONAL REFERENCE NAME, PHONE, E-MAIL, RELATIONSHIP TO YOU? HOW LONG HAVE YOU KNOWN THIS PERSON?
SUMBIT YOUR APPLICATION
You just finished the first step toward applying to be a mentor & we look forward to getting to know you! Your application will be reviewed by the Program Director and you will be contacted regarding an interview, training group dates, & additional steps needed to complete the application process. DRIVE TO THRIVE reserves the right to terminate a volunteer applicant or volunteer at any time if needed.
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