Mentor Application

Are you a new mentor applying to our program for the first time or an existing mentor, renewing your application?

It looks like you are an existing mentor. Did you access this form by clicking email invite you received from our staff?

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 Megan Zanto, Director of Mentor Development at megan@ymionline.org

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

Thank you!

Personal and Contact Information

First Name "Legal" *This question is required.

Preferred Name *This question is required.

Last Name *This question is required.

Street Address *This question is required.

City *This question is required.

State *This question is required.

Zip *This question is required.

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

Mobile Phone *This question is required.

Alternate Phone Number *This question is required.

Pronouns

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

calendar

Partner Information:

Name *This question is required.

Phone Number *This question is required.

Emergency Contact (If different from the person listed above):

First and Last Name

Relationship

Phone Number

Education Information *This question is required.

Field of Study

Employment Information

Company Name *This question is required.

Street Address *This question is required.

City *This question is required.

State *This question is required.

Zip *This question is required.

Position/Title *This question is required.

Industry/Type of Business *This question is required.

How long have you been with this company? *This question is required.

Employer/Supervisor: (Your supervisor may be contacted as a reference.)

Name *This question is required.

Street Address *This question is required.

Apt/Suite/Office

City *This question is required.

State *This question is required.

Zip *This question is required.

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

Phone Number *This question is required.

Alternate Phone

How long have you known this person *This question is required.

If yes, please provide a summary of your involvement:

Please describe:

If yes, please explain:

How did you hear about YMI?

If so, which one?

If you said other, please specify.

Please answer the following questions as thoroughly as possible:

Employer (hidden)

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:

Please provide 1 professional reference and 2 character references. At least one reference has to have known you for longer than 3 years. These individuals may be contacted by phone or email by YMI staff.

Professional Reference

Name *This question is required.

Street Address *This question is required.

Apt/Suite/Office

City *This question is required.

State *This question is required.

Zip *This question is required.

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

Phone Number *This question is required.

Alternate Phone

Relationship *This question is required.

How long have you known this person *This question is required.

Character Reference

Name

Street Address

Apt/Suite/Office

City

State

Zip

Email Address This question requires a valid email address.

Phone Number

Alternate Phone

How did you come to mentor this person?

How long have you known this person?

Character Reference

Name *This question is required.

Street Address *This question is required.

Apt/Suite/Office

City *This question is required.

State *This question is required.

Zip *This question is required.

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

Phone Number *This question is required.

Alternate Phone

Relationship *This question is required.

How long have you known this person *This question is required.

1. I agree to attend a YMI training where I will receive the YMI Mentor Handbook that includes protocols, policies, and procedures as well as Child Abuse Laws in Indiana. *This question is required.

2.

I agree that if I am unable to make our regularly scheduled sessions, due to unavoidable circumstances, I will contact the YMI Campus Coordinator at the school immediately.

*This question is required.

3.

I agree to continue with my mentee for a minimum of 1 (one) academic year. If at any time I need to withdraw from volunteering with YMI, I will give as much advance notice to the YMI Campus Coordinator via email of my inability to serve as a mentor and follow steps provided me for a healthy closure.

*This question is required.

4.

I agree to complete ongoing training opportunities provided by YMI to better equip me for my mentoring role.

*This question is required.

5. I confirm that the information contained in this application is true and accurate. Should any information change I will notify YMI immediately. *This question is required.

6. I understand that failure to adhere to these standards may result in my removal or suspension from participation in the YMI program. *This question is required.

7. I agree to be a YMI Ambassador within my community and sphere of influence. *This question is required.

8. I agree to be responsible for keeping my Safe Visitor background check with the HSE school system up to date, as I understand this is an HSE School Policy. I will also be responsible for the cost of the background check. *This question is required.

9. I confirm that the information contained in this application is true and accurate. Should any information change, I will notify YMI immediately. *This question is required.

10. I agree to follow all HSE School policies regarding COVID19 as outlined in their Return to In Person Instruction Plan. I voluntarily choose to mentor in person and will comply with all set procedures while attending my mentoring sessions. *This question is required.