Application

Thank you for your interest in becoming a HOLLA mentor!

Minimum Requirements for Mentor

  • Must be at least 18 years or older and have completed high school or GED equivalent
  • Be interested in working with young people
  • Be willing to adhere to all program policies and procedures
  • Be willing to complete the application and screening process
  • Be dependable and consistent in meeting the time commitments
  • Attend mentor trainings as perscribed
  • Be willing to communicate regularly with program staff, submit activity information, and take constructive feedback regarding mentoring activities
  • Have access to public transit or an automobile
  • Have a clean criminal history
  • No use of illicit drugs
  • No use of alcohol or controlled substances in an inappropriate manner
  • Not currently in treatment for substance abuse and have have a non-addictive period of at least 5 years
  • not currently in treatment for a mental disorder or hospitalized for such in the past three years 
  • Must be able to commit to at least one year of mentoring

The following are the steps to becoming a mentor:

  • complete an online application
  • provide personal references
  • schedule an informational interview 
  • complete and pass criminal background check 
  • attend an initial culturally responsive mentor training (date TBD) and at least one other training during the year

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
Ethnicity
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
* Why do you want to be a mentor?
* Have you ever had a mentor? How did this person impact your life?
Name and personal pronouns you prefer to be called by
Do you have previous experience in working with youth? If so, how will this experience inform your mentoring?
* Being a mentor is not easy. We ask our mentors to dive deep into the lives of students and their families. Can you commit to a minimum of 4-8 hours per month with your mentee for the 2018-2019 school year?
Have you ever had a mentor?
* Have you ever been arrested? If so, when and for what?
* Are you currently using any illegal drugs or controlled substances?
* Have you ever been treated or hospitalized for a mental condition?
* 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?
* Have you ever been investigated or convicted of child abuse, neglect, sexual abuse or molestation of a youth under 18? If yes, please explain.
* T-Shirt Size
* We focus our efforts in the David Douglas and Reynolds School districts. Where are you located in town and how far are you able to travel to meet with a mentee?
* Please include the name, email, phone and relationship for 2 personal references.
* Please include the name, phone number, email and relationship for two professional references.
Electronic Signature
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I certify that all of the information I provided above is true. I agree to let HOLLA use media taken of me and mentee in promotional materials and social media.