Mentor Application

Applicant Information

First Name *This question is required.

Last Name *This question is required.

Date of Birth *This question is required. This question requires a valid date format of MM/DD/YYYY.

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We at MENTOR RI use demographic information to ensure that we serve all communities. If you feel comfortable,
please let us know how you identify from the following choices (check all that apply): *This question is required.

If you said other, please specify.

Are you a member of the LGBTQIA+ Community? *This question is required.

Occasionally it is important for a match to be matched on these affiliations. Would you feel comfortable being
matched based on the answers you submitted? *This question is required.

Street Address *This question is required.

Apt/Suite

City *This question is required.

Zip *This question is required.

Preferred Email Address *This question is required. This question requires a valid email address.

Home Phone Number

Mobile Phone *This question is required.

How many years have you lived at this address? *This question is required. This question requires a valid number format.

Previous Address

Street Address *This question is required.

Apt/Suite

City *This question is required.

Zip *This question is required.

Are you Currently Employed?

(This will not affect your candidacy to become a mentor)

Status

If you said other, please explain

Employment Information

Company Name

Street Address

Apt/Suite/Office

City

Zip

Work Email Address

Work Phone Number

Current Role

Program Descriptions

Warwick Elementary Mentor Program
School based mentoring program offered to students in grades K-5. Mentoring is conducted on school grounds, during the school day. Traditional one to one mentoring for one hour each week during the school year.

Woonsocket Mentor Program
School based mentoring program offered to students in grades K-12. Mentoring is conducted on school grounds, during the school day. Traditional one to one mentoring for one hour each week during the school year.

Warwick Secondary Mentor Program
School based mentoring program offered to students in grades 6-8. Mentoring is conducted on school grounds, during the school day. Traditional one to one mentoring for one hour each week during the school year.

Aquidneck Island Mentoring Program
School based mentoring program offered to students in grades K-8. Mentoring is conducted on school grounds, during the school day. Traditional one to one mentoring for one hour each week during the school year.

Highlander Charter Mentoring Program
School based mentoring program offered to students in grades 6-8. Mentoring is conducted on school grounds, during the school day. Traditional one to one mentoring for one hour each week during the school year.

DelSesto Mentoring Program
School based mentoring program offered to students in grades 6-8. Mentoring is conducted on school grounds, during the school day. Traditional one to one mentoring for one hour each week during the school year.

Juvenile Justice Initiative Program
The Juvenile Justice Initiative is a comprehensive approach to provide young people, particularly those of color, diversionary options to the formal justice system. BIPOC youth are disproportionately represented in the juvenile justice system. Our goal is to serve 235 youth between ages 12 and 17. MENTOR Rhode Island will work with the referred young person to provide an encouraging mentor to help guide them in making healthy choices.

If you said other, please specify. *This question is required.

If you said other, please explain: *This question is required.

If you said other, what language?

How did you hear about mentoring? *This question is required.

If you said other, please specify. *This question is required.

Mentor Application

Welcome