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Dr. JAM Mentor Application
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Mentor Information
Last Name
*
Your answer
First Name
*
Your answer
Age
*
Choose
18
19
20
21+
Mobile Phone Number
*
Your answer
E-mail Address
*
Your answer
What College/University Do You Attend?
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Choose
California State University - San Marcos (CSUSM)
Point Loma Nazarene University
San Diego State University (SDSU)
University of California, San Diego (UCSD)
University of San Diego (USD)
Other
Graduate
Background Information
Have you ever been accused, arrested, charged, or convicted of child abuse or molestation?
*
Choose
Yes
No
Have you ever been convicted of a felony?
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Choose
Yes
No
Are you an illicit drug user?
*
Choose
Yes
No
Have you ever been convicted of an alcohol or drug related crime?
*
Choose
Yes
No
Mentor Commitment
Can you commit to the Dr. JAM Calendar Year (OCT - MAY)
*
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Yes
No
Can you commit to spending 4 hours a month with your mentee?
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Choose
Yes
No
Can you commit to meeting your mentee twice a month?
*
Choose
Yes
No
Can you commit to contacting your mentee once a week. (text, email, call, etc...)?
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Choose
Yes
No
Can you commit to communicate regularly with the program coordinator and submit activity logs (via website)
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Choose
Yes
No
What's your major?
*
Your answer
What are you outside interests besides school related activities?
*
Your answer
What organizations are you a part of?
*
Your answer
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