Bridge Builders Mentor Application
Fill out form below and we will be in contact!
Email address *
Name: *
Your answer
Address: *
Your answer
City: *
Your answer
State: Zip Code: *
Your answer
How long have you lived at this address? if less than five years, please list below.
Your answer
Birthday: *
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cell phone#: *
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Education: (highest level completed)
Your answer
Availability - are you interested in mentoring weekly or monthly- tell us your ideal
Number of days per week: (check all applicable) *
Required
Marital Status: *
Children? *
Work Phone:
Your answer
Background Check Information: Will you agree to have BBCM program check your background through federal and state agencies for criminal records? *
Do you have a valid Driver's License *
State Issued:
Your answer
Why do you want to be a mentor?
Your answer
Do you have any previous experience volunteering, mentoring, or working with youth?
Your answer
Do you have any hobbies or special skills? If so, what?
Your answer
What support or resources would you need to become a successful mentor?
Your answer
Personal Reference: (please fill out name, address, and phone number of 2 personal references)
Your answer
In an emergency, notify: *
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Please read carefully before submitting:
By submitting this mentor application, you attest to the truthfulness of all information listed on this application. You agree to let our program confirm all information listed and to conduct a federal and state criminal records check.
All information is kept confidential and is property of Bridge Builders Counseling & Mentoring, a 501c3 non profit.
A copy of your responses will be emailed to the address you provided.
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