Young Women Empowered · Y-WE 2018-2019 Mentor Application

Y-WE 2018-2019 Mentor Application

Thanks for your interest in becoming a mentor with Young Women Empowered (Y-WE). When you get involved with Y-WE, you join a high-spirited, intergenerational, and multicultural community that unites diverse adult women with youth ages 13 and up who are dedicated to building a positive future for themselves and the world.

Please look over the application below and prepare to complete and submit it in one session. You WILL NOT be able to save the form mid-way through. We apologize for any inconvenience.

Name

First Name

Last Name

Preferred Name (if different than name listed)

Which Y-WE program are you applying to?

Y-WE Lead

Y-WE Nature Connections

Youth Leadership Council (YLC)

Environmental Leadership Council (Part of Y-WE Nature Connections)

Gender Prounoun

She/Her, They/Them, He/Him, etc.

Age

Birthdate

(mm/dd/yyyy)

Please upload a picture of yourself

Primary Phone Number

Additional Contact Number

Home Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Mailing Address (if different)

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Employer/School

Job Title/Position/Year in School

College(s) Attended

Are you a veteran?

Yes

Ethnicity/Culture/Race (optional)

Are you fluent in English?

Yes

Please list any other languages you speak fluently

Dietary preferences (check all that apply)

No special dietary needs

Vegetarian

Vegan

Pork Free

Dairy Free

Gluten Free

Other

If you selected "other" please explain:

How will you get to our program?

Drive Myself

Friend or family member will drive me

Public Transport

If you are able to drive or get a ride, are you able to pick up youth and mentors who need transport?

Yes

Number of seats available in your vehicle

Emergency Contact Information

#1 Name of Emergency Contact

First Name

Last Name

#1 Emergency Contact Phone

#1 Relationship to You

#2 Name of Emergency Contact

First Name

Last Name

#2 Emergency Contact Phone

#2 Relationship to You

If you have any safety or medical concerns which will affect your ability to participate in specific activities during our programs, please tell us about them:

Are there any accommodations you need regarding physical space, allergies, environmental sensitivities, etc.?

YWE is dedicated to creating inclusive spaces and programs for all, including people with disabilities and specific accommodation needs.

Mentor's Personal Information

Your answers to these questions help us to get to know you better and understand what inspired you to apply to be a mentor at Y-WE. We shape our programs around the passions and goals of the women and youth who participate--so your answers to these questions really matter to us! This program is here to support YOU and our youth in the best way possible.

How did you learn about Y-WE

What do you hope to gain or experience through mentoring in Y-WE’s programs? What are some of your personal goals?

Do you have any mentoring or youth work experience? Please describe

Special skills, talents, qualifications, areas of knowledge, or field of expertise:

We at Y-WE primarily have a group mentoring approach, however some participants wish to be mentored one-to-one. Are you open and available to be paired in a one-to-one mentoring relationship?

Yes

If so, please tell us a bit about your availability to mentor girls one-on-one and the areas you'd like to assist girls with (For example: college essays, SAT prep, cooking, conflict resolution, etc.)

Your Commitment to Y-WE:

As a mentor, your consistent attendance is essential! Please check the dates of the program you are applying for to make sure you can attend most of the program. If you have questions about this, please contact us. If mentoring is too large a commitment at this time, consider becoming a Y-WE volunteer. Our many short-term volunteer opportunities also provide meaningful experiences working with the Y-WE community.

I understand the commitment I am making to Y-WE

Yes, I commit to attending

Is there anything you would like us to know about you, your schedule, or your commitment to this program?

Scholarship Fund Contribution

Y-WE programs are offered on a sliding scale and the majority of Y-WE youth participants are from low-income families. Some of our mentors have requested the option to sponsor youth participants by contributing to our scholarship fund. The cost of full tuition for one youth in Y-WE Lead or Y-WE Nature Connections is $1,000. The majority of our participants can only afford to pay $25-$150. If you would like to make a donation to our scholarship fund and help ensure that Y-WE youth can continue to have this life-changing experience, we welcome your support. You are under no obligation to contribute, participation is entirely voluntary.

Making a contribution is entirely optional and will have no bearing on your acceptance as a mentor.

Yes, I'd like to contribute

I am not able to contribute at this time

Amount

$500

$250

$100

$50

$25

Donation Schedule

References

Please list two non-family members who can comment on your interpersonal, mentoring and/or professional skills.

Reference #1

First Name

Last Name

#1 Phone Number

#1 Email

#1 Relationship to you

Reference #2

First Name

Last Name

#2 Phone Number

#2 Email

#2 Relationship to you

Thank you so much for applying! If there's anything else you'd like to tell us, please do so here. Thank you!