Mountain Mentors matches caring adult volunteers with youth ages 8 to 16. Apply today to become a mentor, and make a difference in the life of a local young person. Mountain Mentors is a program of Summit County Youth & Family Services.

First Name*

Middle Name*

Last Name*

Email Address*

Home Phone*

Work Phone*

Mailing Address*

Physical Address*

Age (all applicants must be 21 or older)*

Marital Status*

Gender*

Have you applied to Mountain Mentors in the past?*

Yes

No

Are you willing and able to make a one-year commitment to Mountain Mentors?*

Yes

No

Why are you interested in becoming a Mountain Mentor?*

How did you hear about our program?*

What qualities, skills or other attributes do you have that will help you be a good mentor? How will they help?*

What volunteer and/or work experiences do you have that involve(d) youth?*

How do you like to spend your free time (interests, community organizations, professional memberships, other activities)?*

What family members or friends do you have in Summit County? How would you describe these ties?*

How would you describe yourself? How would others describe you?*

Please list and explain any changes you anticipate in your family status, occupation, education or residence in the next year.*

Please list and explain any changes you have had in your family status, occupation, education or residence in the past year.*

Which age group(s) are you interested in mentoring?*

Ages 8-11

Ages 12-16

Why are you interested in this/these age group(s)?*

Do you have any friends who may be interested in becoming a Mountain Mentor?*

Yes

No

May we follow up with you in the future about these contacts?*

Yes

No

References

Please list four character references, including one blood relative, one friend you have known for at least two years, one person who lives with you and one past or present employer. Please also include two alternates, in case we cannot reach the four primary references.

Reference Name*

Relationship*

Length of Relationship*

Phone*

Reference Name*

Relationship*

Length of Relationship*

Phone*

Reference Name*

Relationship*

Length of Relationship*

Phone*

Reference Name*

Relationship*

Length of Relationship*

Phone*

Alternate Reference Name*

Relationship*

Length of Relationship*

Phone*

Alternate Reference Name*

Relationship*

Length of Relationship*

Phone*

I grant my permission to the persons listed above to release all pertinent information to Mountain Mentors, understanding that this information is to remain confidential.*

Yes

No

I hereby state and affirm that all the information I have provided above is true and correct to the best of my knowledge.
I understand and agree that Mountain Mentors has the discretionary right to deny my application for any reason at any time, to dismiss a Mentor from the program for any reason during their involvement with said program, and to withhold the reasoning for denial or dismissal. Mountain Mentors also reserves the right to re-match a child if it is felt that this will serve the child’s best interests.*

Yes

No