Mentor Program Volunteer Application
We value your privacy and will only use this information for purposes directly related to our program.

Signing up is a two step process.
STEP ONE: Please complete and submit this form for our program
STEP TWO:  Send a copy of your driver's license to Ally Rubalcaba at arubalcaba@lmusd.net  

Please contact Ally Rubalcaba with any program questions.  

THANK YOU!!!
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Applicant Name
As it appears on your driver's license. 
*
Email Address  *
Primary Phone *
Preferred Contact Method  *
Gender *
Employer Name *
Job Title  *
What is your inspiration for becoming a Mentor?
This will help us match you with a student who might share your interests.
*
Your Hobbies and Interests
This will help us match you with a student who might share your interests.


*
Referred by

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Volunteer Terms and Conditions
A.    VOLUNTEER understands and agrees that, while performing in a volunteer capacity, he/she is not an employee of the DISTRICT and is not entitled to salary or benefits of any kind normally provided to employees of the District.

B.    VOLUNTEER agrees to defend, indemnify and hold harmless the District, its Board of Trustees, employees and agents from any and all liability of loss arising in any way out of volunteer’s negligence in the performance of this AGREEMENT, including but not limited to any claim due to injury and/or damage sustained by the volunteer.

C.    VOLUNTEER agrees to provide proof of negative tuberculosis test prior to service if required.

D.    VOLUNTEER agrees to comply with all Federal, State, Municipal and District laws, rules and regulations that are now, or may in the future become applicable to the volunteer, including compliance with Education Code 35021- Requirements for Voluntary service in Schools.

E.    VOLUNTEER understands that, in connection with his/her application as a volunteer, the District can obtain information bearing upon my volunteer services, including Megan’s Law information and public record information, documenting convictions, civil judicial actions, tax liens or outstanding judgments against.

I understand that if I am accepted as a volunteer, any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal.  By submitting this application, I acknowledge that I agree to these terms and conditions.
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