MENTORING MANUAL

Name

First Name

Last Name

Phone

Country

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact Name

First Name

Last Name

Emergency Contact Relationship

Emergency Contact Phone

Country

(###)

###

####

Emergency Contact Email

What Age Group Are You Interested in Mentoring?

Have You Ever Been A Mentor Before?

Why Do You Want To Be A Mentor w/ 1st Lady Empowerment Foundation, Inc.

Have You Worked With Youth Before?

Have You Ever Been Convicted of a Crime?

If Yes, What Are The Circumstances?

Occupation

Employer Name

List Hobbies, Skills and any Dreams/Goals You Are Working on Right Now.

Reference Name #1

List names of people who can attest to your character and have known you for at least a year. No Relatives.

First Name

Last Name

Reference #1 Phone

Country

(###)

###

####

Reference #1 Email

Reference Name #2

List names of people who can attest to your character and have known you for at least a year. No Relatives.

First Name

Last Name

Reference #2 Email

Reference #2 Phone

Country

(###)

###

####

I Will Complete the Mentoring Training Course & Quiz

I Will Communicate with the 1st Lady Empowerment Foundation, Inc. staff about any Issues or concerns that may arise.

I Will Meet With My Mentee Regularly.

I Will Commit To My Mentee For At Least 6 Months.

I Will Consent to a Background Check and Child Abuse and Neglect Databases for criminal records and driving records.

I Give Permission For My Likeness, Name, Audio or Photos made at 1st Lady Empowerment Foundation to be used for media, social media, marketing, etc.

I HAVE READ AND UNDERSTAND THE MENTORING MANUAL & CODE OF CONDUCT FOR BECOMING A MENTOR. IF SELECTED, I WILL FOLLOW THE RULESOF THE PROGRAM.

SIGN FULL NAME (PRINTED NAME)

By signing, I agree to the terms and conditions. I have completed this form with honest answers.

Date

YYYY

Time

Hour

Minute

Second

Mentee Name

First Name

Last Name

Date of Birth

YYYY

Parents' Name

First Name

Last Name

Phone

Country

(###)

###

####

School Name

Grade Level

Why Do You Want A Mentor

What Are Your Hobbies and Interests?

What Are Your Goals & Dreams?

Parents' Permission