Mentor Application Mentor Application Thank You for your interest in volunteering as a BCYMP Mentor. After you complete this form, the BCYMP Mentoring Coordinator will email you the training steps you'll need to take before being matched. We will also ask you to complete a form that gives BCYMP permission to run a background check. Finally, after you complete your training, we'll ask you to attend a brief interview to answer any questions you may have and to allow BCYMP to tell you more about the specific needs in our community. These steps help us make the best possible Mentoring Match. Also, we ALWAYS need more Mentors, so please share this opportunity and application with any caring, responsible adult you know who'd be willing to spend one hour a week with student(s) in need of guidance and support. To the world you may just be one person, but to one person, you may be the world. #BCYMPBeOne About You Name * Date of Birth * Gender * Female Male Other Ethnicity * Local Address * Local Address Local Address Local Address City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal Email * Home Address (If you are an SDSU student, please put your home address, too.) Home Address (If you are an SDSU student, please put your home address, too.) Home Address (If you are an SDSU student, please put your home address, too.) Home Address (If you are an SDSU student, please put your home address, too.) City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal Phone Numbers Cell Phone * Carrier * Can we text you? Yes No Home Phone Work Phone Education Years of School * Enter location and years completed. Are you an SDSU student? * Yes No Enter your major and expected graduation date. * Background Do you have a valid drivers license? * Yes No Expiration Date * Has an employer or other organization run a Background Check on you in the last six months? Yes (If available, please email the results as a attachment to office.bcymentoring@gmail.com) No Have you ever been convicted or arrested for a Felony Offense? If yes, explain. * Yes No Please explain, * Have you ever been investigated in connection with a child abuse. molestation or neglect matter? If yes, explain. * Yes No Please explain, * Mentoring Questions How did you hear about bcymp? * Why would you like to be a bcymp mentor? * Please select which type(s) of mentoring you're interested in. (May select more than one option.) * 1:1 Mentoring Small group mentoring with social-emotional focus (4-6 Mentees / 2 Mentors) Small group mentoring with academic focus (4-6 Mentees / 2 Mentors) If you would be interested in group mentoring with an academic focus, please indicate which subjects and student age groups you're comfortable supporting. * Can you meet as often as our program requires? (1 hr/wk for at least one year for 1:1 mentoring; if you're gone for the summer, BCYMP can accommodate your schedule.) BCYMP Mentors matched with small groups need to volunteer at least 1 semester or summertime. * Yes No Do you have any previous experience volunteering or working with youth? If yes, please list. * Yes No Please list. * Please list any of your hobbies/interests that would help us to better match you with a BCYMP Mentee: * 19. What grade(s) do you prefer to mentor? (Check all that apply.) * Early Elementary Upper Elementary Middle School High School Do you prefer that your mentee be a particular gender? * Male Female No preference Are you willing to support a Mentee that has unique social, learning, and/or physical needs? * Yes No Maybe Please describe any personal or educational experiences you have with people who have unique needs, and/or describe the kinds of individual needs you are comfortable supporting. * BCYMP serves all of Brookings County, it is often hard to find Mentors in the smaller communities. Please select which cities you are willing to have your Mentee from (select all that apply): Aurora Brookings Bruce Bushnell Elkton Sinai Volga White Preferred City to Mentor: Can you speak other languages? * Yes No Please list. * Reference 1 (not family) References: Please list the name, phone number, email, and connection for two personal references (not family) that you have known for at least one year Name * Email * Phone * Connection * Reference 2 (not family) References: Please list the name, phone number, email, and connection for two personal references (not family) that you have known for at least one year Name * Email * Phone * Connection * Did someone recommend you to the program? Yes No Name What else? Is there anything else you'd like to share about yourself and/or the kind of student you'd like to mentor? As part of the screening process, BCYMP will run a criminal background check before matching you with a K-12 grade student. Are you able to help BCYMP serve more kids by making a donation towards the expense of running your background check? Yes, I can donate 100% of the expense up to $60. Yes, I can donated 50% of the expense, up to $30. No, I'm sorry, but can't make a donation at this time. I certify that all the information above is correct. Clear Email Date Submit
