Mentor Application

We are grateful for your interest in the mentoring program for SSAS. We welcome your enthusiasm and commitment. The basic eligibility requirements to become a mentor include: completion of a post-secondary degree, minimum of 4 years of professional experience, and commitment of 8 -10 hours per year over 4 years.

Name(Required)

First Last

Date of Birth(Required)

Email(Required)

Phone(Required)

Home Address(Required)

Street Address Address Line 2 City State ZIP Code

Employer Name:(Required)

Work Phone(Required)

Employer Address Address(Required)

Street Address Address Line 2 City State ZIP Code

Position(Required)

Years in Position(Required)

Preferred Mailing Address(Required)

Home

Work

Post-secondary education(Required)

Degree(s) and major(s)(Required)

Have you worked with young people before? Please explain.(Required)

(If you have been a mentor before, please include organization, phone and contact person.)

Other community or volunteer activities

Can you commit to mentor your student for four years and see them at least once a month?(Required)

Yes

Please indicate time(s) of day and day(s) of week that work best for you to mentor:

Please answer the following to help us match you with a student:

Please list activities you enjoy doing in your spare time:(Required)

What activities would you consider participating in with your student?(Required)

What special talents, skills or areas of expertise would you like usto know about you?(Required)

Please list two personal references (neighbor, friend, and co-worker) and one professional reference (boss, work supervisor, clergy) that have known you for at least a year.

A) Personal Reference Name(Required)

First Last

A) Personal Reference Phone(Required)

A) Personal Reference Email(Required)

A) Personal Reference Relationship to you(Required)

B) Personal Reference Name(Required)

First Last

B) Personal Reference Phone(Required)

B) Personal Reference Email(Required)

B) Personal Reference Relationship to you(Required)

C) Professional Reference Name(Required)

First Last

C) Professional Reference Phone(Required)

C) Professional Reference Email(Required)

C) Professional Reference Relationship to you(Required)

You will be sent a link from Commercial Investigations LLC to complete a background check as required by our organization and insurance carrier.

This field is for validation purposes and should be left unchanged.

Please answer the following to help us match you with a student:

Please list two personal references (neighbor, friend, and co-worker) and one professional reference (boss, work supervisor, clergy) that have known you for at least a year.

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