Application

Thank you for your interest in becoming a HOLLA mentor! The following are the steps to becoming a mentor:

  • complete an application
  • schedule an informational interview and complete background check paperwork 
  • attend a culturally responsive mentor training (October 18th from 6-9pm at Warner Pacific College) 

Please complete this application and include a photo so that we can make mentor badge for you. Thank you! 

Basic Information
* First Name
* Last Name
Email Address
Contact Information
Home Address 1
Home City
Home State
Home Zip Code
Mobile Phone
Preferred Method of Communication
Home PhoneCell Phone
Work PhoneEmail
Basic
* Date of Birth
Photo
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Demographic Information
* Gender
Primary Language
Other
Secondary Language
Secondary Language Other
Ethnicity
Other
Other
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
Public Transit
Interests
Skills/Interests
Career Focused Interests
Career Focused Interests Comments
Mentor Preferences for Match
Age Range
Education
School Name
Education Level
Other
Start Date
End Date
Program Questions
Name you prefer to be called
* Why do you want to be a mentor?
* Mentoring a young person is a big responsibility and can change the lives of both the mentor and the mentee. What do you hope to gain from the experience and what do you hope the mentee gains from the relationship?
* Have you ever been treated or hospitalized for a mental condition?
* Have you ever been arrested? If so, when and for what?
* Are you currently using any illegal drugs or controlled substances?
* Have you ever had a mentor? How did this person impact your life?
Do you have previous experience in working with youth? If so, how will this experience inform your mentoring?
* Are you willing to communicate regularly and openly with program staff, provide monthly information regarding your mentoring activities, and receive feedback regarding any difficulties during your participation in the mentoring program?
* T-Shirt Size
* Can you commit to a minimum of 4-8 hours per month with your mentee for the 2017-2018 school year?
* Where are you located in town and how far are you able to travel to meet with a mentee?
Electronic Signature
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I agree to allow HOLLA to use media taken of me and my mentee in promotial materials.