Connect. Mentor. Empower.

Contact Information

Please give your current address & phone number below.

Phone* (xxx-xxx-xxxx)
Email*
Confirm Email*
Country
State / Province*
Address
City
Date of Birth (xx/xx/xx)*
Gender*
If you selected "other" please specify:
T-Shirt Size*
  • Small
  • Medium
  • Large
  • Extra Large
  • XX Large
If student, major/area of study ("N/A" if not applicable)*

Personal Reference

Please provide us with the phone number of one professional reference

(non-family member).

Name of Reference*
Relation to Applicant*
Reference Phone Number*
Reference Email

Availability

Which day(s) of the week are you able to participate in One2One mentoring? Please select all available times

Program Availability*
  • Tuesday: 8:00 - 9:30am Brooklyn Middle
  • Tuesday: 1:25 - 3:00pm North View
  • Tuesday: 1:45 - 3:15pm Crest View
  • Wednesday: 8:00 - 9:30am Brooklyn Middle
  • Wednesday: 1:25 - 3:00pm North View
  • Thursday: 8:00 - 9:30am Brooklyn Middle
  • Thursday: 1:45 - 3:15pm Crest View
  • I cannot mentor at this time, but please contact me in the future.
Transportation*
  • I have transportation to/from program & can give rides
  • I have transportation to/from program but I cannot give rides
  • I will need a ride to/from program

Background Information

Please note that your responses won't necessarily impact your ability to mentor.

Have you ever been charged with a felony or misdemeanor?*
  • Yes
  • No
If yes, please provide some additional information about the situation.
Have you ever been accused (rightly or wrongly) or investigated for sexual improprieties with a minor?*
  • Yes
  • No
Have you ever been abused (e.g. sexually, physically, emotionally, etc.)?*
  • Yes
  • No
If yes, please comment on your recovery process.

Thanks for filling out the One2One Mentor Application. Once you click submit you will receive a confirmation email telling you how to set up an interview with us!

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