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Mentoring Application

Our Mentoring Program is a mutually beneficial experience that pairs youth ages 6-12 years old in need of additional adult presence in their lives with a trusted adult mentor from the local community. Mentor matches are encouraged to spend a minimum of four hours a month together participating in activities that can help expand each person’s worldview including volunteering, trying new foods, making crafts, participating in fun activities, attending local events, and more. Our Mentoring Program also brings all matches and youth on the waitlist together once per month for planned social and creative activities.

After filling out the form you will be contacted by Cathy Pierson, Director of Volunteer and External Relationships, in the near future.

Contact Information


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Mentors received background checks and home visits. For the mentee's safety, it is required that we know the members of your household










REFERENCES


Please list the names, complete mailing addresses, and phone numbers for each reference.

Please list the names, complete mailing addresses, and phone numbers for each reference.

Please list the names, complete mailing addresses, and phone numbers for each reference.

Please list the names, complete mailing addresses, and phone numbers for each reference.

Please list the names, complete mailing addresses, and phone numbers for each reference.

Authorization for Release of Confidential Information

I understand it will be necessary for The LeaderShop to investigate my background and to check my character references. I hereby give my consent for this information exchange and authorize such agencies to release information requested by The LeaderShop. I understand that the agencies to be contacted will be employers, courts (juvenile and adult), police, social services and other persons and agencies I have had contact with.