EmailMe Form - Minds of the Future Foundation Mentor Application

Minds of the Future Foundation is a not for profit program, we aim to provide students in the 8th-12th grade with academic tutoring once a week, career counseling, and job shadowing opportunities monthly. Mentors and mentees meet once a month (Minimally) at the mentor workplace to provide job-shadowing experience. Through the course of the school year, students are required to attend academic tutoring once a week at Minds of the Future Academy for one hour provided by tutors, meet with the foundation counselor to review their job shadowing experience and continue to do career exploration on the career they chose to ensure they are working toward a career goal. If the student and mentor finds the career choice is NOT a match for what the student envisioned, the student may be reassigned a mentor. The foundation will contact mentors quarterly for updates on the mentees experience. Please keep in mind the focus of this foundation is to provide students career experience for their desired career and focus on building a long-term relationship that ideally lasts until the mentee graduates from high school. If you have questions about the information requested below, please contact Minds of the Future Foundation at (904) 866-2562.

Can you agree to these criteria? *

I will be able to meet with my mentee once a month during the school year to provide job-shadowing opportunities.

I don’t foresee any moves or job changes that would prevent me from mentoring for the next year.

I will attend a minimal of 2 events in the school-year to support the mentee.

Name *

First Last

Preferred Name

Preferred Mailing Type:

Standard Mail

Email

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Home Phone *

### - ### - ####

Cell Phone *

### - ### - ####

Work Phone *

### - ### - ####

Ext

Email *

Gender

Male

Female

Rather not say.

Ethnic Indicator: Hispanic/Latino

Yes

No

Race

If other, please indicate here.

What is your highest level of education completed?

How did you hear about Minds of the Future Foundation?

Name/Location/Site

Identify all service organizations, faith-based entities or community groups you are affiliated with:

If Faith-based, enter here:

If other, enter here:

Employment Information

Name of Employer

Occupation

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Job Description

References

Please provide at least 3 references, two of which are employer references

Name

Relationship

Phone

### - ### - ####

Email

Name

Relationship

Phone

### - ### - ####

Email

Name

Relationship

Phone

### - ### - ####

Email

Do you have any anticipated future changes that would affect your ability to mentor such as a job change, extended travel, military deployment, plans to study abroad, internship participation, student teaching, etc.?

Yes

No

Don't Know

If Yes, what activity and when (year) will this activity happen?

Have you ever been investigated or charged with any crimes?

Yes

No

If Yes, pleae explain below:

Why are you interested in being a mentor? *

What are you hoping to get out of this experience? *

What do you hope your mentee will get out of this experience? *

Have you previously applied to be a volunteer with a youth serving organization? If so, which organization(s)? *

I give permission for Minds of the Future Foundation to run a criminal and abuse registry check and to contact any of the youth serving organizations that I have listed above. Background checks will be run every three years.

Clear

Please sign above