Mentor Program Application

Thank you for your interest in becoming a mentor at Sophia Academy! If you have any questions, please contact: Washawn Jones, Director of Advancement at 401-784-0021 x201 or wjones@sophia-academy.org.

Name

First Name

Last Name

Date of Birth

YYYY

Optional: What is your race/ethnicity?

Home Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Are you currently attending college? If yes, please list the name of the institution and program of study

Employer Name and Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Employer Phone

(###)

###

####

Current Title

AVAILABILITY AND EXPERIENCE

The mentor program will require you to connect with your mentee on a weekly/biweekly basis for 30 minutes to 1 hour. What weekdays and times are you available to mentor?

Please provide a brief description of your background and relevant skills.

Have you ever worked with children before?

If yes, what age and in what capacity?

Are you a parent, guardian, or directly involved in a child's upbringing?

Please describe any special interests that may be helpful in matching you and your mentee

Please briefly explain why you would like to become a mentor.

How did you hear about our program?

REFERENCES

Please list 2 personal and/or professional references.

Reference 1 Name

Reference 1 Phone

(###)

###

####

Reference 1 Email

Reference 1 Relationship

Reference 2 Name

Reference 2 Phone

(###)

###

####

Reference 2 Email

Reference 2 Relationship

PROFESSIONAL HISTORY

Please list your last two places of employment.

Company Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Company 2

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

E-SIGNATURE

I understand that Sophia Academy mentoring takes place on school grounds, during school hours, unless otherwise specified, and that I must obtain a national BCI check prior to beginning my mentorship.

Please type your name to acknowledge: