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Mentor Application

First Name

Middle Name

Last Name

Street Address *

Street Address Line 2

City *

State/Province *

Postal Code *

Cell Phone Number

Work Phone Number

Home Phone Number

Email *

Birth Date *

Month

Day

Year

Highest Level of Education *

Some high school, no diploma

High school graduate, diploma or the equivalent

Some college credit, no degree

Trade/technical/vocational training

Associate degree

Bachelor’s degree

Master’s degree

Professional degree

Doctorate degree

High School

College/University

Major

Graduate School

Previous Mentoring Experience - Name of mentoring program

Location of Mentoring Program

Start date

Month

Day

Year

End date

Month

Day

Year

Please tell us about your mentoring experience:

Current Employer

Job Title *

City *

State/Province

Start Date

Month

Day

Year

Previous Employer

Job Title

City

State/Province

Dates of employment

Month

Day

Year

to

Month

Day

Year

Matching Information

Please give us as much information about yourself as possible to help us make the best possible mentoring match.

Why are you interested in being a mentor? What do you hope to gain through mentoring a teen? *

The DCFYI program works with children in foster care ages 12 and older. What age teen do you think you would be comfortable mentoring and why? *

Please tell us about your interests and hobbies: *

Is there anything else you would like us to know? *

References

Please give the names of two people, not related to you, who can provide a reference. Ideally, at least one will be a work-related reference.

Reference 1

First Name *

Last Name *

Phone Number *

Email *

Reference 2

First Name *

Last Name *

Phone Number *

Email *

Emergency Contact

First Name *

Last Name *

Phone Number *

Phone Number 2

Email *

Do you have a current driver's license? *

Yes

No

License State

License No.

Please be aware that you will be asked to complete a Department of Motor Vehicles record check. You must have fewer than 5 points to be able to transport a child in your vehicle.

Have you ever been convicted of a crime, other than a traffic violation? *

Yes

No

Explain conviction

Have you ever had a complaint or allegation filed against you by either child or adult protective services? *

Yes

No

Complaint explanation

Have you ever been required by any licensing board or professional ethics body to surrender your license or have you ever been found guilty of a violation of professional ethics codes, professional misconduct, unprofessional conduct, incompetence or negligence, in any state or county? *

Yes

No

Ethics/Negligence Explanation

Mentor Application

Leave this field blank

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First Name *

Last Name *

Email Address *

How did you hear about DCFYI?

Why are you interested in volunteering?

Leave this field blank

Contact Us

Address: 853 New Jersey Avenue, SE Suite 200, Washington, DC 20003
Address for mail: PO Box 15497, Washington, DC 20003
Phone: (202) 863-0975
Email: info@dcfyi.org
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