Application

 

Please complete the application in its entirety. You will be sent additional information regarding the Mentor Orientation dates.

This is a school-based Mentoring program match visits will not take placeon Saturday or Sunday.

If possible, please upload a recent photo.

COBB COUNTY SCHOOL DISTRICT

Thank you!

 

 

Basic Information
Prefix
* First 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 PhoneCell Phone
Work PhoneEmail
Basic
* Date of Birth
Photo
No file is currently uploaded.
Upload File
Marital Status
Military Service
Tobacco, Alcohol, and Drug Use Histroy
Demographic Information
* Gender
Primary Language
Other
Ethnicity
Other
Other
Disability
Type of Disability
Type of Disability Other
Availability
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
1. Before School
2. AM Block
3. Lunch
4. After School
5. PM Block
Interests
Skills/Interests
Mentor Preferences for Match
Age Range
Race
Education
Education Level
Other
Year Degree Attained
Major
Referral
Date Expressed Interest
Recruitment Source
Target Audience
Program Questions
* Date Sent to School
* What are your strengths and your challenges?
* What are your experiences with children (past and present) that will assist you in mentoring?
* Many of our students in need of a supportive adult come from challenging circumstances. How comfortable would you feel mentoring a student identified with the following issues? Abused, Loud, Obese, Hyperactive, Poor Hygiene.
* Area you Interested in Participating in the Speakers Bureau, Group Mentors or One on One Mentoring?
* What is your Area of Expertise
* Many of our students in need of a supportive adult come from challenging circumstances. How comfortable would you feel mentoring a student identified with the following issues? Abused, Loud, Obese, Hyperactive, Poor Hygiene
For Females: Would you consider a cross gender match (elementary only)?
* Please describe yourself, strengths, weaknesses and relevant childhood experiences.
* What is the time commitment that would work with your schedule?
* Why do you wish to be a mentor?
* What do you like to do in your spare time?
* For Females: Would you consider a cross gender Match? (Elementary Only)
* Many of our students in need of a supportive adult come from challenging circumstances. How comfortable would you feel mentoring a student identified with the following issues? Abused, Loud, Obese, Hyperactive, Poor Hygiene.
* What areas can you support your Mentee
* In looking at the District Map sent to you. Can you select a school that would be convenient for you to be matched at?