Mentor Application Personal InformationDate Date Format: MM slash DD slash YYYY Name* First Last Date of Birth Date Format: MM slash DD slash YYYY Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Home PhoneCell Phone*Social MediaInstagramFacebookTwitterEmployment and Volunteer HistoryMost Recent Employer:Date Began Date Format: MM slash DD slash YYYY Date Ended Date Format: MM slash DD slash YYYY PositionSupervisor's NameSupervisor's TitleSupervisor's Email Supervisor's PhoneApplication Questions Please answer all of the following questions.1. Why do you want to become a mentor?2. Have you mentored previously?3. What qualities and/or skills do you feel you have that would benefit youth?4. Can you commit to participate in Generation Love Mentoring program for a minimum of one semester from the time you are matched with a mentee?5. Are you available to meet with a young lady 6-8 hours a week? Please list availability and scheduling issues.6. Describe your physical and mental health. Are you currently taking any medications? If so, please explain.7. How do you view yourself as a person?8. How would your friends, family and co-workers describe you?10. Have you ever been convicted of a DUI? If yes please explain.11. Have you ever been treated or hospitalized for a mental disorder? If yes please explain.12. Have you ever been investigated or convicted of child abuse or neglect? If yes please explain.13. Have you ever been investigated or convicted of sexually abusing or molesting a youth 18 or younger?14. Are you willing to communicate regularly and openly with program staff, provide monthly information regarding your mentoring activities, and receive feedback regarding any difficulties during your participation in the mentoring program? This iframe contains the logic required to handle Ajax powered Gravity Forms.