Partnership 4 Kids Mentor Application
Goal Buddy Application
Mentor Basic Information
* Legal First Name
Preferred First Name
* Legal Last Name
* Have you ever gone by a different last name?
If Yes, What was it?
* Date of Birth
* Social Security Number
* Address
* City
* State
* Zip code
* Have you lived in any other cities in the past 7 years?
If yes, please list cities and states
Home Phone
Cell phone
Work phone
Work phone ext.
* Email Address
Secondary Email
What is the best way to reach you?
Gender
Ethnicity (optional)
Race
Languages Spoken
If other:
How did you hear about Partnership 4 Kids?
If in the military, do you expect to be deployed within the next 6 months? (optional)
Employer
Occupation
Photo Upload
No file is currently uploaded.
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Emergency Contact Info
Contact name
Contact phone
Contact relationship
Mentor Preferences
Volunteer Type
Availability
Is there a volunteer you'd prefer to work with?
Preferred Grade Levels (1-6)
Preferred School
  
Names and contact information of anyone you know who might be interested in volunteering
Driving and Criminal Record
Is there anything on your driving or criminal record that we should be aware of before processing your application please explain:
Media Release

I acknowledge receipt of the 'Media Release' and certify that I have read and understand the terms of release. Click here to view the release.

* Media Release Signature
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Media Release Date
Summary of Your Rights Under the FCRA

I acknowledge receipt of the 'Summary of Your Rights Under the FCRA' and certify that I have read and understand these rights. Click here to view the summary.

* FCRA Signature
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FCRA Date
Disclosure Regarding Background Check

I acknowledge receipt of the 'Disclosure Regarding Background Check,' and certify that I have read and understand this document. I hereby authorize Partnership 4 kids to obtain all required screenings and reports. Click here to view the disclosure.

* Disclosure Regarding Background Check Signature
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Disclosure Regarding Background Check Date
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