City Rocks Mentor Application
Please submit the following application by SEPTEMBER 30, 2019
MENTOR REQUIREMENTS AND ELIGIBILITY:
1. MUST BE AT LEAST 23 YEARS OLD
2. HAVE A SOCIAL SECURITY #
3. ATTEND A 3 HOUR TRAINING
4. COMPLETE A FINGERPRINT BACKGROUND CHECK (one time fee of $60)
5. COMMIT TO AT LEAST 4 HOURS PER MONTH FOR A FULL SCHOOL YEAR.
The Program Director will be sending you information on all of the above. If you have any questions about the application or the City Rocks Mentoring Program please contact the Program Director at
Year of Birth
Cell Phone *
Name of Employer
Brief Description of your Job (Role, responsibility, skills, etc.)
1. What do you feel are the strengths (bi-lingual, academic skills, previous relevant volunteer / education/ working with young people / experience. etc.) you bring to this program?
2. Write a brief statement on why you have chosen to participate in the mentoring program.
3. Please check the box next to the two statements below:
I understand that I will be required to participate and complete a three hour mentor training and submit to a background check
I understand that I will be required to spend at least 4 hours per month with my mentee between October and June of the current school year.
4. Within the past 10 years have you ever 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?
5. Are you under current indictment or has a district/county attorney accepted an official complaint for any of the offenses in question #4?
6. If the answer is Yes to questions 4 or 5 please explain below:
7. Educational Background:
Some High School
High School Graduate
8. References - please list three- one family member, one personal friend and one work reference (name and contact info)
In submitting this application to be a mentor volunteer, I understand that Brooklyn Boulders Foundation City Rocks, routinely performs criminal background checks of all volunteers for the position of mentor for which I'm applying. This check may be done o me 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 misinformation knowingly provided here, and on subsequent mentor application forms is grounds for dismissal. (sign/type name and date)
City Rocks Supplemental Matching Form
Please give us as much background information on you in this section as possible - we use this information to help match you with a mentee who has similar background and interests.
At which BKB Gym do you prefer to mentor
Either one is fine with me
List some of your hobbies and interests, and extracurricular activities
What kind of music do you like?
What kind of sports do you like to watch and / or play?
What are some of your favorite TV shows?
Do you speak another language?
What are some of your favorite Movies?
What are some of your favorite books?
What are some of your favorite foods?
What were some of your favorite subjects in school?
What is something you'd like to get out of your mentoring experience?
What else is there about your background that you'd like to tell us that could help us in matching you with your mentee?
What days of the week are your preferred days for meeting with your mentee (after school on weekdays or on weekends or either)?
A copy of your responses will be emailed to the address you provided.
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