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

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