Mentor Application

Saratoga Mentoring Program
368 Broadway—Suite 16
Saratoga Springs, New York 12866
info@saratogamentoring.org
518-581-1487

Name:
Address:
Permanent Address (Skidmore Students):
Home Phone:
Work Phone:
Cell Phone:
Email:

Best time/place for us to contact you:

Birthdate:

Race/Ethnic Identification:

Profession/Occupation/College/Situation:

Please list current and past employment including name of company, address and phone number, and dates of employment:

Relevant previous employment and/or experience (please include dates):

How did you hear about Saratoga Mentoring?

Please describe involvement you have had with young people through other organizations, programs, community activities, and/or family?

Why would you like to become a mentor?

Please indicate if you speak a language other than English.

What is your educational background?

What ideas do you have for activities and/or field trips with your mentee?

Are you able to commit for a full year to spend approximately two hours weekly with a child?

Do you have any preferences as to the age or interests of the child with whom you will be matched? (We serve ages 7-18.) If so, what are they?

Do you have transportation?

Yes No

Non-familial References: Please list three non-familial references that have known you for at least one year whom we can contact. Include at least one employer, past or present,  if applicable. If you are not employed, please list at least one reference from a community organization. (For example, a clergyman, volunteer supervisor, or a representative of a local organization.) References will remain strictly confidential

1. Name/Relationship:

Phone:

Address:

2. Name/Relationship:

Phone:

Address:

3. Name/Relationship:

Phone:

Address:

Please feel free to include a resume or any additional information of interest.

Personal References: Please list one personal reference that have known you for at least one year whom we can contact. This can be a spouse/partner or close family member or friend. References will remain strictly confidential

1. Name/Relationship:

Phone:

Address:

Affirmation: To the best of my knowledge, the above information is true and correct. I grant my permission to verify my employment and to contact the above references. (Online applicants can provide consent/signature at the time of the Volunteer Interview.