MENTOR RUSD
MENTOR APPLICATION
Personal Information:
Name___________________________________________________________ Gender ÿ Male
First Middle Last ÿ Female
Address ______________________________________________________________________________
Street City State ZIP
Home phone ___________________________ Mobile phone __________________________________
Name/address of employer _______________________________________________________________
Work phone ___________________________ Occupation ____________________________________
E-mail address ________________________________________________________________________
Volunteer Information:
1. Indicate your grade preference: ÿ Elementary
ÿ Jr. High/Middle School
2. What do you feel are the strengths (bilingual, math skills, previous relevant volunteer experience, etc.)
you can bring to this program?
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
3. Write a brief statement on why you have chosen to participate in the mentor program.
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
4. Initial the two statements below:
_____ I understand that the mentor program involves spending a minimum of one hour every week for
the academic year at a school with an assigned student.
_____ I understand that I will be required to complete the mentor program orientation.
5. ÿ Yes ÿ No Within the past 10 years, have you been convicted of any felony or misdemeanor
classified as an offense against a person or family, or an offense of public indecency or a violation
involving a state/federally controlled substance?
Resume Templates 1210 Document(s)
