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Mentor Application

Transforming Our Communities Through the Power of Mentoring

Welcome!
Thank you for your interest in becoming a mentor! The application will take an average of 30 minutes to complete. All information collected on this application is confidential. If you need help or additional support, please don't hesitate to email the Program Coordinator at sara@kinshipcc.org. 

Thank you for time!

The Kinship Mentoring Team 
Contact Information
This question requires a valid date format of MM/DD/YYYY.
calendar
Gender *This question is required.
This question requires a valid email address.
Please provide a 10-digit phone number including area code.
Enter numbers only. Formatting such as dashes will be added as you enter your phone number.
Do you have children? *This question is required.
Children
Are you currently employed? *This question is required.
Employment Information
May we contact you at work?
EDUCATIONAL RECORD: (please fill the school and number of years completed)
Did you graduate?
Have you ever served in the military? *This question is required.
Military Service
Are you affiliated with a church or religious institution? *This question is required.
How would you describe your present health? *This question is required.
PoorFairGoodExcellent
Are there any present conditions which may be relevant regarding your relationship with a child?  *This question is required.
Have you ever been diagnosed with or received treatment for any of the following? (include dates and other relevant information)
Do you have a valid driver’s license? *This question is required.
Driver's License Information *This question is required.
Do you have your own car? *This question is required.
If no, do you have regular access to a car? *This question is required.
Do you have current insurance? *This question is required.
Insurance Information *This question is required.
Have you had any moving violations or accidents in the last 5 years? *This question is required.
Do you anticipate any major life changes within the next year?  *This question is required.
Have you ever been arrested? *This question is required.
How did you learn about the Kinship Program? *This question is required.