Mentor Application

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Please list the names and complete addresses of one work reference. (References will have known you at least two years and are willing to discuss your character, reputation, and ethics.)

Reference

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Drivers License and Insurance Information:

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Do you know someone else who might be interested in being a mentor?



City of Dreams does not discriminate on the basis of race, creed, educational level, physical disability, age, gender, sexual orientation, or marital status.

The above information is true to the best of my knowledge. I understand that I am not obligated, if called upon, to perform volunteer mentor services herein applied for, and that the agency is not obligated to assign, or actively seek to assign a student to me. I further agree to allow City of Dreams to elicit additional pertinent, personal information as part of the matching process.

In the event that I am chosen to mentor a youth, I agree to the commitment and to participate to the best of my ability. I will honor confidential information regarding my student. I will be free of the influence of alcohol or illegal drugs when with students on or off school grounds. I will inform the Project Coordinator of any changes in my address and/or phone numbers. I will inform the Project Coordinator in advance should I choose to stop volunteering.

Check this box to signify that you accept these terms before submitting this form: