Chica Project Mentor Application 2017-18
Thank you for your interest in becoming a Mentor!

If you have any questions do not hesitate to contact Maria Paredes at maria.chicaproject@gmail.com
Name *
Last name *
Street Address *
City *
State *
Zip Code *
Date of Birth *
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Gender
Phone Number *
Email Address *
Occupation *
What is your education level? *
What do you feel are the strengths you will bring to this program?  Example: bilingual, math skills, previous relevant volunteer work etc. *
Write a brief statement on why you have chosen to apply to the Chica Project Mentoring Program. *
Have you been a mentor with us before? *
If you answered yes, why do you want to be a mentor with us again? If no, why do you want to become a mentor? *
Group Mentoring Program Models
At our organization we have two models:

1. Empowerment Institute (EI) - Develops the next generation of young leaders by preparing them to be the authors of their own story. We accomplish this through hands-on workshops that promote personal growth, leadership advancement, and identity exploration with a cohort of high-school youth in a group mentoring setting. (At a minimum workshops will be twice a month, during school hours).
Current High Schools the EI serves:
-Cathedral High School, Boston
-Lawrence High School, Lawrence
-KIPP Academy Collegiate, Lynn

2. Community Based Model - Takes place every third Sunday of the month in participating cities October through June.
Which mentoring model are you interested to be a part of? (You can select both if that is the case) *
Required
If you selected Empowerment Institute please specify which High School would you prefer. *
Required
What qualities would you like to see in a mentee? *
What individual has served as a role model for you? Why? *
If you could recommend one book for your mentee to read, what would it be? *
Initial below for the following statement: I understand that the Mentor Program involves attending a minimum of 80% of  workshops. *
Initial below for the following statement: I understand that the Mentor Program involves attending 1-2 events of Chica Project *
Within the past 10 years, have you been convicted of any felony or misdemeanor classified as an offense against a person or family, or an offense of public indecency or a violation involving a state/federally controlled substance? *
Are you under current indictment or has a district/county attorney accepted an official complaint for any of the offenses in the previous question? *
If you answered YES to the previous two questions, please explain below:
Please list a Reference's Name [John Smith], Relationship, Address [10 Smith St, John MA, 01432], Phone Number, Email *
Please list a Reference's Name [John Smith], Relationship, Address [10 Smith St, John MA, 01432], Phone Number, Email *
Please sign this application by entering your name and the date below: In completing this application, I understand that the Chica Project routinely performs criminal and driving record checks of all volunteers for the position of mentor, for which, I am applying. This check may be done if I sign below. If I fail to sign, it may be grounds for rejecting me as a mentor. I certify to the best of my ability that the information provided on this application is true and accurate. I also understand that providing misinformation knowingly, and on subsequent mentor application forms, is grounds for dismissal. *
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