ProVetus · ProVetus Mentor Program(prospective mentor form)

ProVetus Mentor - Welcome and Introduction

Thank you for beginning this application to become a mentor for Pro Vetus. Pro Vetus is a non-profit organization focused on providing peer-mentoring support to returning Veterans as they reintegrate into civilian life and thrive as our next generation of leaders. Our mission is to help Veterans and Service Members successfully transition from the military to the civilian sector especially within the five critical domains: employment, housing, family/legal support, social/community network, and medical care. After completing the mentor application, the Pro Vetus team will review your application and contact you concerning further steps in the mentor selection process. Stay connected, at www.provetus.org, as we share helpful transitional resources, Veterans' stories, news and events, and further information regarding the Pro Vetus partnership with the Teachers College Veteran and Family Resilience Center at Columbia University!

Please check which program you are participating (check all that apply):

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Middletown NY Veteran Treatment Court (mentor must be a Veteran)

Westchester Veteran Treatment Court (mentor must be a Veteran)

Contact Information

Q1. Name

First Name

Last Name

Email

Verify Email

Address

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Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Phone

*

Q2. What is your gender

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Female

Male

Other

Education

Please enter the name of each school, dates attended, and degrees received. For colleges, please indicate the field of study for each degree.

Q3: Name of School

Years Attended

Degree Received

Q4: College - Name of School

Years Attended

Degree Received

Q5: College - Name of School

Years Attended

Degree Received

Q6: College - Name of School

Years Attended

Degree Received

Employment History

Please write in the name of your company, the years you worked at this company, your job title, and your job description/responsibilities for each position you choose to list.

Q7: Job # 1 - Name of Employer

Job Title

Years Employed (YYYY-YYYY)

Please describe your job responsibilities at this position.

Q8: Job #2 - Name of Employer

Job Title

Years Employed (YYYY-YYYY)

Please describe your job responsibilities at this position.

Q9: Job # 3 - Name of Employer

Job Title

Years Employed (YYYY-YYYY)

Please describe your job responsibilities at this position.

Military History

Q10: Have you ever served in the military ?

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Yes

No

If yes, in what branch did you serve?

If yes, what were your years of service ?

If yes, please indicate locations and dates of all deployments:

Q11: Do you have a close relationship/family ties to someone in the military ?

Yes

No

If yes, please briefly describe the relationship.

Volunteer Experience & Interest

Q12: Please describe any past volunteer experiences. Include the name of organization, a description of your role, and the duration of your service.

Q13. Why are you interested in becoming a mentor with ProVetus ?

Q14: How do you usually spend your time, including leisure activities and responsibilities ?

Q15: How many hours per week are you willing/able to commit ?

References

Please submit a professional or personal reference - someone who can speak to your work ethic and / or volunteer experience is ideal.

Q17: Name of Reference

Reference's Position / Job

Your Relation to the Reference

Reference Phone Number

Q18: Do you consent to a routine background check ?

Yes

No

Birthdate