Application

If you would like to become a mentor in our Youth Mentoring Program, please complete the application and submit it to Children's Aid Society. If you have any questions while completing your application, please contact Jenna at (814) 765-2686 x209.

Basic Information
* First Name
Middle Name
* Last Name
Email Address
Contact Information
Home Address 1
Home Address 2
Home City
Home State
Home Zip Code
Home Country
Home Phone
Mobile Phone
Work phone
Work phone ext.
Preferred Method of Communication
Home Phone Cell Phone
Work Phone Email
Social Media
Facebook
Twitter
Website
Basic
* Date of Birth
Photo
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Marital Status
Household Income
Spouse First Name
Spouse Last Name
Military Service
Owns a Firearm
Tobacco, Alcohol, and Drug Use Histroy
Motivational Factors
Demographic Information
* Gender
Sexual Orientation
Primary Language
Other
Ethnicity
Other
Primary Religion
Other
Disability
Type of Disability
Availability
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
1. Before School
2. AM Block
3. Lunch
4. After School
5. PM Block
Transportation
Own Car
Drivers License
Drivers License State
Drivers License Province, State, or Subnational Division
Drivers License Country
Drivers License Number
Drivers License Issue Date
Drivers License Expiration
Interests
Skills/Interests
Career Focused Interests
Mentor Preferences for Match
Age Range
Race
Willing to be matched with mentee from home with a history of
Education
School Name
Education Level
Other
Start Date
End Date
Year Degree Attained
Major
Referral
Date Expressed Interest
Recruitment Source
Target Audience
Motivation
Documents
Document 1
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Document Type 1
Document Type 1 Other
Document 2
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Upload File
Document Type 2
Document Type 2 Other
Program Questions
* Work hours
* How long employed
* County
* Have you ever been involved with or volunteered for another youth organization?
* Highest level of education
* Have you ever been denied acceptance or released from service as a volunteer or employee for another youth serving organization?
* Occupation