Men As Peacemakers

Books are the quietest and most constant of friends: they are the most accessible and wisest of counselors, and the most patient of teachers.

-Charles W. Eliot

The more that you read, the more things you will know. The more that you learn, the more places you'll go.

-Dr. Seuss

In-School Mentoring Online Application

Contact Information First Name Middle Name Last Name Home Address City State Or Province Postal Code Home Phone Work Phone Best Time to Contact You Email Address

Previous / Permanent Address Previous Address

(if student, give permanent address)

City State Or Province Postal Code Permanent Phone Other state residences & dates

Employment Employer Occupation Business Address City State Or Province Postal Code Business Phone Working Hours Can we call you at work? Hours worked per week

Other Information Race How long employed? Place of Birth Date of Birth Sex Currently a student? School No. of Hours

Experience / Background Information Have you ever applied to our agency or any other volunteer program? If yes, When and where? Have you ever been a mentor before? If yes, please list name and location of agency Have you ever had any other volunteer experience? If yes, please list agency and type of experience Do you have any physical or mental condition which may limit your ability to server as a mentor? If yes, please describe Have you ever been accused, charged or convicted of a crime? If yes, explain How long have you lived in the Twin Ports Area? How did you hear about Mentoring Works?

Personal References

Please list the names and addresses of three (3) persons who can vouch for your reputation and character and who have known you for at least two (2) years.
When listing personal references, please use the names of people who have seen you work with children.
Please notify your references and encourage them to return their reference form as soon as possible after receiving them.

Reference 1 Name Address City State Or Province Postal Code Home Phone Work Phone Email

Reference 2 Name Address City State Or Province Postal Code Home Phone Work Phone Email

Family Reference Name Address City State Or Province Postal Code Home Phone Work Phone Email

Employer or Supervisor Reference Name Address City State Or Province Postal Code Home Phone Work Phone Email

Preferred School Nettleton Lowell Lincoln Kenwood Raleigh Congdon

The undersigned acknowledges and agrees that

He/she is not obligated, if called upon, to perform the volunteer services herin applied for and that the agency is not obligated to assign, or actively seek to assign him/her a child and
As a part of the agency's assessment process, additional information may be elicited from the applicant by agency personnel.
I also agree to contact Men As Peacemakers staff if any critical information (ie: License revocation, DUI's, criminal charges and/or convictions) occur after I have become part of the Mentoring Works! program.
I understand that by being accepted as a mentor, I will subsequently be considered a member of Men As Peacemakers.

Signature Date

Accessibility Information

Getting men off the sidelines and involved in Making Peace

In-School Mentoring Online Application