What do you feel are the strengths (bilingual, math skills, previous experience, etc.) that you can bring to the program?

• I understand that the mentor program involves spending a minimum of 4-5 hours per month with my assigned match.  
• I understand that I will be required to complete the initial 3 hour Mentoring 101 training and additional trainings for support as needed.  

Within the past 10 years, have you been charged  or convicted of any felony or misdemeanor classified as an offense against a person or family, or an offense of public indecency or a violation involving a state/federally controlled substance?

In making this application to be a volunteer, I understand that the North Star Mentoring of Erie County Independent Living Program routinely performs child abuse, criminal and driving record checks of all volunteers for the position of mentor for which I am applying. This check may be done on me if I sign below. If I fail to sign, it may be grounds for rejecting me as a mentor.

I certify to the best of my ability that the information provided on this application is true and accurate. I also understand that misinformation knowingly provided here, and on subsequent mentor application forms, is grounds for dismissal.

If my original child abuse clearance is on file with my employer, I give permission for North Star Mentoring of Erie County Independent Living Program to contact my employer for verification.    

Adapted from materials provided by Mentoring Partnership of Long Island, The ABC’s of Mentoring, and California Governor’s Mentoring Partnership.