Adult Mentoring

Adult Mentoring - MENTOR Application

- Personal Information:

Full Name

Age

Marital Status

Gender

Address

City

ZipCode

Home Phone

Cellular phone

Email

Best method to contact you

Best time to call you

Ethnic background

Which country(s) did you grow up in?

Language(s) spoken

Hours per week you can commit to Mentor program

How many months can you commit to the program (12 preferred):

Areas you want to help adults with (guidance for gender relations, Islamic Values...etc):

What age do you prefer to mentor (starting 16yrs and above)

- Academic Information: (optional)

Applicable if you are in school or graduated from college/university in the past two years

Highest Grade level

What are/were your academic interests

Are/were you involved in social activities at school

Please specify what activities

How can your academic and work experience help your mentees

Please provide one academic reference:

Can we contact your reference (if needed):

- Career Information:

Current Employer

Work Phone:

Best time to call you (if needed)

Please provide one professional reference

Can we contact your reference (only if needed):

- Social Information:

What do you like to do for “fun!”:

What type of movies do you enjoy:

What outdoor activities/sports do you enjoy:

Have you had any social experience that taught you a lesson, and if so and if you’re comfortable with it please share

What else do you like to do for fun?

Who is (are) your role model (s) and why?

Please provide 2 personal references:

- Mentoring Information

Why are you interested in becoming a mentor:

Have you been a mentor before? if yes Where and when?

If you have had mentorship experience, please describe the positives and the negatives:

If you have had mentorship experience, how can you use it to benefit this program:

Are you willing to invest several months of thoughtful interaction with your mentee

Are you willing to work closely with your mentee’s family if required

How will you develop trust between your mentee and yourself

If there is conflict between your mentee and yourself, how will you resolve it

How can you use your past experiences to help your mentee improve

What qualities you possess will make you a good mentor and role model?

Any other comments you would like to share

MCA is providing this volunteering program as a service to the community. I acknowledge that while MCA will support me throughout this program and will help me grow with trainings and mentoring, MCA will not be held liable for any issues that may result from this service. MCA are not liable for any accidents or mishaps that occur during mentoring.

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