Online Mentor Application

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Mentor Application

First Name

Last Name

Date of Birth (mm/dd/yyyy)

Home Address

Home City

Home State

Home Zip

Personal Cell No.

Home Phone

 
Employer Information
Employer

Occupation

Title

Work Address

Work City

Work State

Work Zip

Work Phone

Cellular Phone

Fax

Email

Preferred Mailing Address:

Preferred Contact Number:

 
Clearance Information
Do you have a valid driver’s license?

Do you have car insurance?

Have you ever been convicted of a felony or misdemeanor?

Are you under current indictment or has a distric/county
attorney accepted an official complaint for any criminal offenses?

All applicants will be asked to complete Child Abuse and Criminal Record Clearance Applications.
 
References
Name of Reference(1)

Phone Number

Email Address

Relationship

Name of Reference(2)

Phone Number

Email Address

Relationship

 
Personal Profile
College(s) Attended:

Degree(s) Attained (B.A., M.S., etc.) and Year(s) Graduated:

Major(s):

Volunteer and Community Activities:

Please check the activities and interests that apply to you:

Sports you play:

Sporting events you attend:

Other Interests:

 
Personal Profile Continued
When you were 15, what did you want to be when you grew up? Why?

Who or what was the biggest influence on your decision to attend college? Please briefly describe this influence and its impact on you.

What do you specifically hope to offer a high school student in a mentoring relationship?

Please describe any limitations or restrictions to the time you are available for mentoring responsibilities.

Do you have any transportation restrictions? (If yes, please explain.)

What are three special talents, skills or areas of expertise that you would like us to know about you?

Do you have any specific strengths (language skills, math skills, reading skills, etc.) that would be helpful for us to consider in matching you with a student?

 

I understand that the Sponsor-A-Scholar (“SAS”) mentor expectations include the following key points:

  • My official commitment to the SAS mentoring relationship begins when I am matched with my student and continues until my student completes his or her first year of college.
  • The SAS Program requires that I complete an orientation and requests that I attend at least two training sessions/mentor roundtables during the year.
  • SAS mentoring involves at least a weekly phone call and a monthly visit with the student.
  • I give Philadelphia Futures permission to use my name and photograph in its publications.
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