Skip survey header

Mentor Application



Please stop the application process and launch this application form using the invitation in the email you received. If you require a link, please contact  Mindy Medalen, Program Director at mindy@ymionline.org

This will ensure a seamless process and prevent delays with your application.

Thank you!
Personal and Contact Information
This question requires a valid email address.
Gender *This question is required.
This question requires a valid date format of MM/DD/YYYY.
calendar
Age *This question is required.
Race/Ethnic Identification: We attempt to match our students and mentors with as many commonalities as possible. This information is not required but can be extremely helpful especially as students request or need a mentor sharing their race/ethnic identification.
Social Media: We hope to use Facebook as a way to build relationships between YMI mentors and encourage mentoring related conversations. Please specify if you use either FB or Twitter and provide User Name so we can find you.
Marital Status: *This question is required.
Spouse Information:
This question requires a valid email address.
Relationship *This question is required.
Education Information *This question is required.
Highest Level of Education *This question is required.
Employment Status *This question is required.
Employment Information
Employer/Supervisor: (Your supervisor may be contacted as a reference.)
This question requires a valid email address.
T-Shirt size *This question is required.
Do you have any previous experience (formally or informally) mentoring youth? *This question is required.
Do you have any experience and/or training to be equipped to mentor students? (check all that apply): *This question is required.
Do you speak any other language other than English? *This question is required.
If yes, which language(s)?
Have you ever been arrested or convicted of a crime? *This question is required.
Have you ever been convicted of a DUI or DWI? *This question is required.
Have you ever been convicted of child abuse or neglect? *This question is required.
Have you ever been investigated and/or convicted of sexually abusing or molesting a minor? *This question is required.
Have you ever received treatment for alcohol and/or substance abuse? *This question is required.
Have you ever been hospitalized for mental illness/disorder? *This question is required.
How did you hear about YMI?
Referral Type *This question is required.
Please enter the specific Publication/Location/Person/Event related to the Referral Type question above:
Are you a member of a local church?
Please answer the following questions as thoroughly as possible:
Our philosophy at YMI is, “Share YOUR Life to Change a Life” and we truly believe that our unique life experiences, both the good and the bad, are a significant part of the mentoring role. You can assist us in the matching process by checking any of the Life Experience labels that you feel you are especially equipped for:
Life and Situations Experienced *This question is required.
Check next to any of the words below that you think describe your personality. *This question is required.
Check all topics and activities that interest you. *This question is required.Please check a minimum of 5.
Please list the names and contact information of people who have agreed to be listed as character/professional references on your behalf. At least one referral has to have known you for longer than three years. These individuals may be contacted by phone or email by YMI staff.
Relative
This question requires a valid email address.
Former Mentee (if you have mentored in the past)
This question requires a valid email address.
Friend/Acquaintance
This question requires a valid email address.
2nd Friend/Acquaintance
This question requires a valid email address.