Name
*
First Name
Last Name
Email Address
*
Phone
(###)
###
####
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Why would you like to become a mentor?
*
Would you be willing to complete a personal background check?
*
Yes
No
Have you ever been convicted or plead guilty to any crimes? If yes, please explain.
*
Have you ever been refused by a youth program as a volunteer? If yes, please explain.
*
Please list your special professional training if any, skills, hobbies and interests
Community affiliations (church groups, service organizations, clubs etc).
Previous volunteer experience ( include name of organization, contact name and telephone number)
What experience do you have working with children?
Do you have experience working with children that have experienced trauma?
What interests you about becoming a mentor?
What do you hope to gain from becoming a mentor?
Do you have school age children? If yes, what school do they attend?
Other than English, what languages do you speak?
What is the best time of day for you to mentor?
I give my permission for CREW to share my contact information with my mentees teacher and/or school staff
*
I give my permission to CREW to add my name and contact information to an internal roster of mentors
*
As a condition of volunteering, I give CREW and its affiliate schools permission to conduct a background check on me. This may include contacting my references and may include a review of criminal history records, DMV and any registries. I understand that if approved my position is conditional upon CREW not receiving any inappropriate information when reviewing my background. I hereby release and agree to hold harmless from liability CREW and its affiliates.
*
Applicant Signature:
*
Please type your name in the fields below
First Name
Last Name
Date
MM
DD
YYYY
