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Girl Tyme Mentor Application
Please complete application. If you have any questions or concerns, please email GirlTymeMentoring@Gmail.Com
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* Indicates required question
Email
*
Your email
Name
Your answer
Date of Birth
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MM
/
DD
/
YYYY
Address
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Your answer
Email
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Your answer
Phone number
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Your answer
Current occupation?
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Your answer
Are you currently enrolled into school? If yes, provide attending school
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Your answer
Highest Grade Completed
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High School Diploma
Some College
Associates
Bachelors
Masters
Doctoral
Required
Why are you interested in becoming a Mentor?
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Your answer
Do you have any previous experience volunteering or working with youth? If so please specify.
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Your answer
How would you describe yourself as a person?
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Your answer
What are you expectations for Girl Tyme?
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Your answer
Please provide a brief introduction about yourself; you can include things such a your favorite foods, hobbies, things you like to do at home, general interest and anything else you'd like your potential Mentee to know about you
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Your answer
Are you willing to participate in mandatory monthly activities?
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Yes
No
Are you available to meet/ contact with your assigned Mentee two days a week? Please explain any particular scheduling issues.
Your answer
Are you willing to communicate regularly and openly with program staff, provide weekly logs/ reports regarding your mentoring activities, and receive feedback regarding any difficulties during your participation in Girl Tyme?
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Yes
No
Are you willing to complete an interview with the board?
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Yes
No
Girl Tyme Mentoring Program requires a one year commitment, is there anything that would disrupt your one year involvement?
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Your answer
What qualities are you looking for in a mentee?
Your answer
Have you ever been arrested or convicted of a crime? If so, please explain.
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Your answer
Have you ever been investigated or convicted of abuse or neglect? If so, please explain
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Your answer
Emergency Contact (name, relation and phone number)
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Your answer
Please list 2 references
Your answer
Please sign and date. This affirms that all above information is true to the best of your knowledge.
*
Your answer
Girl Tyme Mentoring Consent Form
Thank you for your interest in the Girl Tyme Mentoring Program. We pride ourselves on being accountable to the community and engaging in safe practices throughout our program.
Please check each of the following:
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I agree to follow all mentoring program rules and guidelines. I understand that any violations will result in a suspension and/ or termination of mentoring status.
I agree to participate in all mandatory monthly activities. If an emergency takes place I will notify founder immediately or I will give 2 weeks notice of unable to attend an event..
I agree to complete weekly logs reflecting my two weekly interaction with my assigned Mentee.
I understand that information about myself will be shared with a prospective mentee and her guardian/ parent. Once a mentee is assigned to me my identity and any other known information about me may be shared with mentee and guardian/ parent to ensure a successful match relationship.
I agree to respect others and any information that is heard or given will remain confidential.
I agree to allow Girl Tyme to use any photographic image of me taken while participating in the mentoring program. These images may be used used in promotion or other marketing material.
I understand that if I have any questions regarding this policy, that I should contact the Program Manager.
Required
Signature and Date
*
Your answer
A copy of your responses will be emailed to the address you provided.
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