Boys & Girls Club Mentor Application: A Guide For Aspiring Mentors.pdf

# Boys & Girls Club Mentor Application

## Applicant Information:

- Name: [Applicant's Full Name]
- Date of Birth: [DOB]
- Social Security Number (SSN): [SSN]
- Address: [Current Address]
- City, State, ZIP: [Full Location]
- Home Phone: [Phone Number]
- Home Email: [Email Address]
- Employer: [Current Employer]
- Occupation: [Job Title]
- Work Address: [Workplace Address]
- Business Phone: [Work Phone Number]
- Fax: [Optional]
- Business Email: [Work Email]

## Mentoring Preferences:

- Preferred Mentoring Day: [Choose one day from Monday to Saturday]
- Best Time for Mentoring: [Morning, Afternoon, Evening - Check all that apply]
- Gender Preference: [Male, Female, No preference]
- Age Group Preference: [Younger youth, Teen, No preference]

## Statement of Interest:

[Write a brief statement here explaining your motivation to become a mentor at the Boys & Girls Club. Share your passion for mentoring and any relevant experiences or skills you can offer.]

## Special Interests/Hobbies:

[List hobbies or interests that could be beneficial in connecting with mentees, such as cooking, arts, sports, technology, etc.]

## Previous Addresses (Last 5 Years):

- [Address 1] (Dates: - to )
- [Address 2] (Dates: - to )

## References:

1. Name: [Reference 1 Name]
Telephone: [Phone Number]
Relationship: [Their Relationship to You]
Address: [Optional]

2. Name: [Reference 2 Name]
Telephone: [Phone Number]
Relationship: [Their Relationship to You]
Address: [Optional]

3. Name: [Reference 3 Name]
Telephone: [Phone Number]
Relationship: [Their Relationship to You]
Address: [Optional]

## Educational Background (Last 5 Years):

- [School 1] (Dates: - to )
- [School 2] (Dates: - to )

## Employment History (Last 3 Positions):

1. Company: [Employer 1]
Occupation: [Job Title 1]
Title: [Optional, if applicable]
Dates: [Employment Period]

2. Company: [Employer 2]
Occupation: [Job Title 2]
Title: [Optional]
Dates: [Employment Duration]

3. Company: [Employer 3]
Occupation: [Job Title 3]
Title: [Optional]
Dates: [Period of Employment]

## Mentor Release Statement:

I acknowledge and agree to the terms outlined in this application, including the rules and regulations of the Boys & Girls Club Mentoring Program. I understand the commitment required and voluntarily release the Club from any liability arising from my participation.

[Signature of Mentor]
[Date]