Apply Now – FAM

Apply For FAM

Mentee Application

Mentor Applicaion

Mentee Application

FAM Mentee Enrollment Form

"*" indicates required fields

Child Information

Child's Name*

Child's First Name Child's Last Name

Nickname*

Date of Birth*

Gender*

Grade*

Phone*

Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Description Of Child

Eye Color*

Hair Color*

Skin Color*

Height*

Weight*

Primary Language*

Are you Hispanic or Latino?*

Which one or more would you say is your race?*

African-American/Black

Native American/Alaska Native

Asian

Native Hawaiian/Pacific Islander

Caucasian/White

Other

Parent/guardian Information

Parent/Guardian Name*

Parent/Guardian Name First Name Parent/Guardian Name Last Name

Relationship to Child*

Primary Language*

Marital Status*

Phone*

Address

Street Address City State / Province / Region ZIP / Postal Code Country

Email*

What is your current employment status?*

Parent/guardian Information

Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Occupation*

Work Hours*

Work Phone*

Education

What is your annual household income?*

How many children do you have?*

Additional Parent/Guardian Name

Relationship to Child

Primary Language

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

What is your current employment status?

Business Address

Address

Street Address City State / Province / Region ZIP / Postal Code Country

Occupation

Work Hours

Phone

Education

What is your annual household income?

How many children do you have?

School Information

Child’s School*

School Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

School Office Phone*

Dismissal Time

Does your child have an I.E.P. (Individual Education Plan) or 504 Plan?*

Signature*

Mentor Applicaion

FAM Mentoring Program

"*" indicates required fields

Full Legal Name*

Preferred Name*

Gender*

Date of Birth*

Ethnicity*

Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Email*

Phone*

Work Number

What is the highest degree or level of education you have completed?

What is your annual household income?*

What is your current employment status?*

Write a brief statement on why you wish to be a mentor in the FAM Mentoring Program:*

Describe special interests and hobbies, which may be helpful in matching you with a mentee (e.g. cooking, crafts, career interests, chess, stamp collecting, sports such as baseball or football, computers, art, needlepoint, speak another language, music, painting):*

What other affiliations (e.g., service or volunteer organizations) do you have?*

What do you hope to gain from the mentoring experience?*

What do you hope your mentee gains from the mentoring experience?*

Will you be able to meet every Wednesday from 4:00 p.m. - 8:00 p.m.?*

Will you be able to meet and/or talk with a student at least (2) hours a week during the school year?*

Do you have prior mentor experience?*

If yes, please explain: (Program Name & Dates)*

Are you willing to have the conduct a background check on you, including fingerprints?*

List three people (non family members) who can serve as character references for you.

Name*

Phone*

Name*

Phone*

Name*

Phone*

I certify that the information I have supplied is correct to the best of my knowledge. I grant permission for you to contact the references provided. I also understand and agree to the duties and requirements described in the Volunteer Duties and Requirements.

Apply For FAM

FAM Mentee Enrollment Form

Child Information

Description Of Child

Parent/guardian Information

Parent/guardian Information

Business Address

School Information

FAM Mentoring Program

List three people (non family members) who can serve as character references for you.

Support Our Work. Donate Now. Make A Difference Today.

Sign Up for Our Newsletter

Receive updates on how lives are being changed all across the state.

SHOPPING BAG 0