Date
*
MM
DD
YYYY
Name
*
First Name
Last Name
Email
*
Home Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Preferred Pronouns
*
Date Of Birth
*
MM
DD
YYYY
Phone
*
(###)
###
####
Driver's License or California (ID Number and State)
*
Emergency Contact (Name and Phone)
*
Are you restricted from interacting or engaging with minors?
*
If yes to the above question, please explain:
Current Employer
*
Years Employed with Current Employer
*
Occupation
*
Employer Phone Number
*
In which industry do you have your primary experience? (select one)
The following questions will be used to match you with a mentee.
In which other industries do you have experience? (select all that apply)
*
What is the highest level of education you have completed?
*
Which languages (other than English) do you speak fluently? (select all that apply)
Which hobbies and interests do you enjoy? (select all that apply)
*
Which extracurricular activities were you involved in while you were in high school? (select all that apply)
*
Please answer the following questions. The purpose of this prompt is to simply get to know you and to understand how best to support you as a prospective mentor in MFC.
Why are you interested in being a mentor?
Please share about a mentor who influenced your life.
Are you confident that you can meet the minimum mentoring commitments?
*
Below are the expectations for mentors with MFC. Please thoughtfully consider and respond to the following question.
• Commit to mentoring a student for nine months.
• Attend personal development workshops with student (once a month for first seven months of the program).
• Commit to developing a community impact project with mentee (final 2 months).
• Contact (phone call, email, text, social media) student once a month outside of workshop.
• Invite student to your job site for job-site tour.
• Attend new mentor orientation/training.
• Respect the wishes and guidelines of mentee’s parents/guardians
Please take a look at the calendar and note that the East LA personal development workshops will take place on the third Saturday of each month (dates may be subject to change).
How did you hear about MFC?
