Teen Mentor Application
This form is intended for teens who want to register to participate in the Skamania County WSU Extension Youth Mentoring program. This application is for youth in grades 6-12. If you wish to register for K-5, please see the Youth Registration Form. Registration is open until all spots are filled. For questions, please contact Phoebe Jud at phoebe.jud@wsu.edu 
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Full Name *
Home Phone
Cell Phone
Mailing Address
E-mail
Age
Which school do you attend?
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What grade are you currently in?
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Please describe why you are interested in being a teen mentor:
Please describe any experience you have working with children younger than you:
What does being a mentor mean to you?
Are there any people in your life that you consider a mentor? How have they helped you?
Are you available for our mandatory 4 hour training on December 5th from 10 am-2 pm?
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Are you familiar and comfortable with using Zoom?
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Do you have access to a reliable internet connection?
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Please check all of the topics you would be interested in having an adult mentor you in
If you chose other, please describe the other interest here
Is there anything else you would like to share with us?
Please list one non-family member we can contact who has knowledge of your skills, abilities and experiences
Reference (Name, relationship to you, phone number, e-mail)
Background Check
Once your reference check is complete, you will be asked to complete a Fingerprint BackgroundCheck. Our Mentoring Program Coordinator will follow up with you on the steps necessary tocomplete this requirement.
We will follow up with you soon. Thank you for your interest!
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