AMP! New Mentor Application for 2021/22 School Year
Thank you for completing this application for the AMP! Metro Richmond (AMP!) Mentoring Program for students at T.C. Boushall Middle School for the 2021-2022 school year. This application is for new mentors. As of today, we are only accepting applications from Genworth and Capital One employees. If you do not work for one of these companies and would like to be placed on a waiting list, please contact us at It is possible we will have more openings in a couple of weeks!

We were hoping to be able to provide some in-person mentoring this school year. However, with the Delta variant that is going around, policies about vaccinations in school and the uncertainty around everything, we have decided to remain all virtual this school year. Virtual mentoring will mostly involve students that are at school in person, while you mentor virtually from home or work. We have learned to roll with the punches!

The time commitment for mentoring is always 1 hour for 1 day a week when school is in session. Mentoring this school year will occur on Wednesdays and Thursdays from 12-1pm and mentors will pick the day that best works for them. This will include about 10 weeks during the Fall of 2021 and 15 weeks during Spring of 2022.

Submitting your application expresses your interest in mentoring with our organization and does not guarantee placement with a student. AMP! program staff will be in touch regarding next steps. Please know that AMP! and Boushall Middle School will keep all information on this application in confidence and will use it solely for purposes of this program.
Personal Information
Name *
(First and Last)
Address *
**Please include full address with city and zip code. This is important for background checks!**
Cell Phone *
Birth Date *
Gender *
Race *
Social Security Number
Needed for background checks, which are done on each mentor every 3 years. We will delete this from our system once we complete this. If you are not comfortable putting it on this form, we will need to get it from you via phone or in person. Please do not include the dashes.
Preferred Email for Communications *
Best way to get in touch with you in case of last minute changes on mentoring days. *
Employment Information
Employer *
Work Phone *
Position in your Organization *
Length of Time in Position *
Application Questions
Please answer the following questions as completely as possible. AMP! and Boushall will use your responses to best match you with your mentee.
Why do you want to become a mentor in this program? *
Do you have any previous experience mentoring, volunteering or working with youth? If so, please specify. *
What qualities, skills, or other attributes do you feel you have that would benefit a middle school-aged student? Please explain. *
Can you commit to participate in the AMP! Metro Richmond mentoring program for the entire 2021-2022 school year? (Oct-April) *
Please list any dates from Oct -April where you could have a conflict and may NOT be able to attend mentoring. *
Our policy is that you miss no more than 2 dates per semester. Once we see your availability, we will let you know if it is still possible for you to participate.
Please let us know which mentoring time slot you would prefer. *
Are you willing to attend one of these mandatory 1.5 hr VIRTUAL mentor training sessions held by MENTOR Virginia? *
This is only mandatory for new mentors and there are a few dates to choose from. Please visit and sign up for the training date that works best for your schedule. Please do not wait until the last minute to sign up as they will occasionally cancel if numbers are low.
We will also hold a 1 hour AMP! Mentor Orientation virtually via Zoom before you begin mentoring. Date and time TBD. *
Do you have the technology to participate in mentoring via Zoom? (either a computer with video capabilities or a smartphone )
Clear selection
If you are a professional, do you have permission from your employer to use time during the lunch hour to volunteer during?
Clear selection
If you are a college student, which semesters are you available to mentor? (We prefer a yearlong commitment.)
How would you describe yourself as a person? *
Please include two things you would like your mentee to know about you.
How would you describe your life when you were in middle school? *
How would your friends, family, and co-workers describe you? *
Are you willing to communicate regularly and openly with program staff, provide feedback regarding your mentoring activities, and receive feedback regarding any difficulties during your participation in the mentoring program? *
This includes an end of year survey.
Please read this carefully before signing
AMP! Metro Richmond appreciates your interest in becoming a mentor. Please type your initials for each of the following:
I agree to follow all mentoring program guidelines and understand that any violation will result in suspension and/or termination of the mentoring relationship. *
I understand that AMP! and Richmond Public Schools (RPS) are not obligated to provide a reason for their decision in accepting or rejecting me as a mentor. *
I agree to communicate regularly and openly with program staff, provide information regarding my mentoring activities, and receive feedback regarding any difficulties during my participation in the mentoring program. *
I agree to allow AMP! and RPS to use any photographic image of me taken while participating in the mentoring program. These images may be used in promotions, newsletters, and/or other related marketing materials.
I understand that this program takes place as a group and is monitored by the program coordinator. Any separate activities I choose to do with RPS are not part of the AMP! mentoring program. Any separate activities I choose to do with the student I am mentoring are not part of AMP!'s mentoring program and require permission from the student's parent or guardian. *
I understand AMP! requires a background screening through First Advantage for all participating mentors. The background check will include criminal history and personal references. *
AMP! will begin that process after volunteers commit to mentoring by attending the New Mentor Training session. AMP! will incur costs related to background screening.
Prior to that background process, please answer yes or no to the following. *
Have you ever been arrested, convicted, or pled guilty or "no contest" to ANY offense other than a minor traffic offense in a court of law?
Have you ever been convicted of ANY sex, alcohol, or drug related offense?
Have you ever been convicted of ANY dangerous crime against children?
Have you ever been investigated or convicted in a case involving the physical or sexual abuse of a child (age 18 or younger)?
Are any criminal charges or proceedings pending against you?
If you answered "Yes" to ANY questions above, explain.
Note: For criminal charges, specify all of the charge(s), date(s), disposition(s), name(s), and address(es) of the court(s) and judgement(s) or conviction(s). (CONVICTION means the final judgement on a verdict or a finding of guilty, or plea of nolo contendere, in any state or federal court of competent jurisdiction in a criminal case, regardless of whether an appeal is pending or could be taken. Conviction does not include a final judgment which has been expunged by pardon, reversed, set aside, or otherwise rendered invalid.)
Please type your name below, and your typed name attests that you agree to abide by the program guidelines and that all information in this document is accurate to the best of your knowledge. *
Personal References
**Returning mentors can skip this section.
Please list the names and phone numbers of two people you would like to use as character references (only people you have known for at least a year and are non-family members). Any information AMP! gathers from these references will be held as confidential and not released to you, the applicant.
How long known
How long known
Mentor Interest Survey
Please complete all of the following. This survey will help AMP! know more about you and your interests and help us find the best match for you.
Do you speak any languages other than English? If so, which languages? *
Is there a specific type of student you feel you would work with best? *
Gender, personality, interests, etc? If you are a returning mentor, you can comment here if you feel you should not be matched with the same mentee as last year.
Would you be willing to work with a child who has disabilities? If so, please specify disabilities you would be willing to work with. *
What are some favorite things you like to do with other people? *
What are your favorite subjects to read/learn about? *
What is your job and how did you choose this field? If you are a college student, what field would you like to go in and why? *
What is one goal you have set for the future? *
If you could learn something new, what would it be? *
What person do you most admire and why? *
Describe your ideal Saturday. *
What are your hobbies and interests? *
Is there any other information you would like us to know about yourself?
Do you need any special accomodations or assistance to participate in this program? If so, please describe below.
How did you hear about AMP!?
Clear selection
Referrals are the best way we find mentors! Can you refer a friend, relative or co-worker who may be interested in mentoring with our program?
Please list their name, phone number and email address.
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