Nurture® Program Mentor Application
Your Name *
Your answer
Your Email *
Your answer
Your Address *
Your answer
Your Mobile Phone Number *
Your answer
How did you hear about the Nurture® Program? If referred by a friend or current mentor, please include her name. *
Your answer
Employment History *
Please list your three most recent employers, dates of employment and reason for leaving.
Your answer
Do you currently work outside the home? *
Current Position and Employer *
If you work outside the home, please list your current employer (company or organization) and your job title.
Your answer
Do you speak a language in addition to English? If yes, what language(s) do you speak? *
Your answer
Volunteer Experience *
If you have volunteered previously, please list those experiences below.
Your answer
References *
Please list three (3) references. You may include personal, work or volunteer references. Please include each reference's NAME, PHONE NUMBER and EMAIL ADDRESS.
Your answer
Please tell us about your experience in parenting, including the age(s) of your child(ren) and why you want to share that experience as a Nurture® Program mentor. What do you hope to gain from this experience? *
Your answer
What, if any, experience do you have outside of parenting that relates to early childhood development, parent support, education, community outreach, counseling, etc? *
Your answer
Any mom who delivers in one of our partner hospitals has the opportunity to enroll in the Nurture® Program. Therefore, the moms you support will have different backgrounds, histories and levels of need. This may include various family structures, a wide range of income levels, possibly drug/alcohol issues, etc. Are there any scenarios that you would feel highly uncomfortable supporting? Please explain. *
Your answer
Do you consider yourself to have strong opinions about 'hot button' parenting topics (vaccinations, co-sleeping, breast/bottle feeding, stay-at-home/working, etc.)? If so, do you feel that you would be able to effectively support moms who might not share your views? Please explain. *
Your answer
Do you have consistent access to a computer/tablet and wifi? *
Does your schedule allow you to commit one to two hours each week to consistently communicate with ten to 15 enrolled moms? *
Do you feel you will be able to consistently reply to texts from moms in a timely manner (within 24 hours)? *
Does your schedule allow you to commit to communicate with your Nurture® Program supervisor on a regular basis? *
Is there anything else related to your application that you would like to share with us?
Your answer
Are you able to make a one (1) year commitment to mentoring moms of newborns? *
We prefer that, during the important and vulnerable first year, moms enrolled in the Nurture® Program maintain the same mentor. A three (3) year commitment from mentors, the entire duration in which moms are enrolled in the program, is most desired.
All candidates are required to complete new mentor training which is offered on-line and to sign a Nurture® Program mentor pledge. *
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