Home

The Problem
Our Guiding Principles
The Results Of Our Work
Get Involved!
Make A Donation
News
FAQ
Contact
 
Mentor Application
How did you learn about the "I Have a Dream" Foundation-Los Angeles?
 
First Name * Middle Last Name *
Sex Birthday Age
/ /
 
Social Security Number
- -
Why are you interested in being a mentor?
Which of your skills and qualities will make you a good mentor?
 
HOME INFORMATION
Address *
City * State * Zip *
Country *
 
 
How long at this address?
If less than one year, how long at previous address?
 
Home Telephone * - -
Cell/Other - -
E-mail *
 
Best time to reach you?
 
EMPLOYMENT INFORMATION
Company/Organization
Occupation
Job Title
Address
City State Zip
 
Phone - -
Fax - -
E-mail
     
Business Hours May we contact you at work? Best time to call?
 
How long with current employer?
How long with previous employer?
 
EMPLOYMENT INFORMATION
First Name Middle Last Name
 
Phone - -
Cell - -
Relationship
 
Personal Information
Married / Single
Spouse
Do you have children?
If yes, list names and ages
Ethnicity:
Driver’s License No. and State
Auto Insurance Co.
Policy Number
Car Make, Model & Year
Are you fluent in language(s) other than English? If so, please list:
Have you ever been convicted of a crime? If yes, please explain
 
Education (Check all that apply)
    School Degree/Major
High School Diploma N/A N/A
Some College
2-year Degree
4-year Degree
Grad School
 
Did you have a mentor growing up? If so, which of his/her qualities helped you grow the most?
 
MENTORING COMMITMENTS AND LIFESTYLE

Are you confident that you can meet the minimum "I Have a Dream" Foundation-Los Angeles mentoring commitments:

  • Commit to one year mentoring a young person in the program
  • Visit mentee twice/month during the first three months and once/month thereafter
  • Contact mentee once/week by phone, email, text, MySpace, etc.
  • Check in with mentee's Project Coordinator approximately once/month
  • Attend a New Mentor Training and at least one In-Service during year of service
  • Respect the wishes and guidelines of mentee's parents/guardians
  • Respect confidentiality of mentee and family, barring situations such as child abuse
What types of activities do you enjoy in your spare time?
What characteristics would you most want your mentee to possess? (calm, full of energy, etc.)
What qualities in a young person would you prefer not to deal with?
How far are you willing to drive to pick up your mentee at his/her home?
Do you smoke?
Anticipated changes over next 12-18 months and, if so, when?
Employment:
Personal Life (marriage, etc.):
Residence:
 
AFFIRMATION

The information I have provided in this application is, to the best of my knowledge, true and complete.  I grant permission for the "I Have a Dream" Foundation-Los Angles to verify this information, contact my references, and run a background check that will include contacting the DMV and the Department of Justice.  I agree to provide a copy of my driver’s license and auto insurance policy, pay the background check fee (currently$12), and to participate in a home interview.  I understand and agree to the mentoring commitments outlined herein. 

 
REFERENCES
A background check will be conducted for each mentoring applicant as required by our insurance company. Please provide the following information: 1) someone who has supervised you either at work, school or as a volunteer; and 2) two personal references who can guarantee your character and morals. We strongly prefer local references who have known you for at least two years. We ask that you please do not list any relatives and that you please provide all of the information requested.
 
Supervisor/Employer Reference
Name
Title
Company/Organization
Address
City State Zip
   
Phone - -
E-mail
 
Personal Reference #1
Name
Title
Company/Organization
Address
City State Zip
   
Phone - -
E-mail
 
Personal Reference #2
Name
Title
Company/Organization
Address
City State Zip
   
Phone - -
E-mail
 
 
 
   
 
© 2003 I Have A Dream Foundation - Los Angeles All Rights Reserved.