Application - Sonoma Valley Mentoring Alliance

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Sonoma Valley Mentoring Alliance
Mentor Application

Please fill out the online Mentor Application form below and click SUBMIT FORM button when you are finished. It is suggested that you complete the application in one sitting, because you are unable to save it and come back to it later. Once we’ve received your application, we will contact you via email or phone within 1 to 3 business days.

In addition, please complete the Fingerprint Form and bring it with you to your fingerprint appointment at the Sonoma Police Station.

Live Scan Fingerprint Form: Fingerprint Form (DOJ-FBI).pdf

Please note: There is a fee for fingerprinting. We reimburse you for this if you bring us the receipt or take a photo and email us the receipt.

Please fill out the form as completely as possible. All information provided is confidential and submitted via a secure server.
(All * fields are required)

Name

Residence Address

City

Zip Code

Mailing Address (if different)

City

Zip Code

Home Phone

Cell Phone

Work Phone

Email Address

Date of Birth

Person to contact in an emergency

Emergency Phone #

Relationship

What best describes your gender?

Male Female Non-Binary A gender not listed

How did you hear about this program? (check all that apply)

Billboard Newspaper Ad Friend/Mentor Fundraising Event Other

Name of Friend/Mentor

Previous residences last 3 years

City

State

Dates

Address

City

State

Dates

Address

City

State

Dates

Employment history past 3 years

Supervisor

Employer Phone

Position/Title

Employer Name

Supervisor

Employer Phone

Position/Title

Employer Name

Supervisor

Employer Phone

Position/Title

Can we contact your Supervisor or Employer as a reference?

Yes No

Highest level education achieved

Name and location of school

Have you ever been investigated for or charged with any offense involving a person under the age of 18?

Yes No

If yes, please explain:

Have you ever been investigated for or charged with any other offenses within the last 10 years?

Yes No

If yes, please explain:

Are you currently a user of illegal drugs?

Yes No

If yes, please explain:

Have you had problems with or been treated for alcohol or drug abuse within the last five years?

Yes No

If yes, please explain:

Do you have any physical or mental condition that would limit your ability to be a Mentor?

Yes No

If yes, please explain:

List 3 references with phone numbers. Please notify the references you provide that we will be calling them for a brief conversation.
Reference #1

Reference 1 Phone #

Reference #2

Reference 2 Phone #

Reference #3

Reference 3 Phone #

Why do you want to mentor a youth in our Program?

What do you hope to gain from your mentoring experience?

What are your hobbies and interests?

Please list any previous experience working with children:

Please list any other non-profit organizations that you have volunteered for:

Personality Traits: (Please check those that describe yourself)

friendly funny quiet serious patient reserved talkative musical outgoing athletic artistic organized curious studious thoughtful

Languages spoken

My interest is in helping a child succeed

Academically Socially Both

I prefer to work with

Boy Girl Either

Age preference

5-7 8-10 11-14

I prefer to mentor at (check all that apply)

Flowery (K-5th grade) El Verano (K-5th grade) Sassarini (K-5th grade) Prestwood (K-5th grade) Altimira (6th-8th grade) Adele Harrison (6th-8th grade) Wherever needed

Days Available (check all that apply)

Mondays Tuesdays Wednesdays Thursdays Fridays

Best Times to Mentor

I understand that disclosure of the information that I have provided in this application will be limited to those employees of the Sonoma Valley Unified School District (“SVUSD”) and volunteers who participate in the selection and evaluation of Mentors for the SVUSD’s Sonoma Valley Mentoring Alliance program. I represent that all of the information I have provided in this application is true and correct and understand that such information will be relied upon by the Sonoma Valley Mentoring Alliance Program in considering my application.

I understand

Signature (type full name)

Date