Application

Thank you for your interest in PLOT. Please fill out the application as completely as you can.  If something does not apply to you please put N/A. Criminal history does not disqualify you from being a mentor with PLOT. 

Basic Information
* First Name
* Last Name
Email Address
Contact Information
Home Address 1
Home Address 2
Home City
Home State
Home Zip Code
Home Phone
Mobile Phone
Work phone
Preferred Method of Communication
Home PhoneCell Phone
Work PhoneEmail
Basic
* Date of Birth
Marital Status
Spouse First Name
Spouse Last Name
Military Service
Demographic Information
* Gender
Sexual Orientation
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
Education
School Name
Education Level
Other
Start Date
End Date
Year Degree Attained
Program Questions
* Do you speak any languages other than English?
* Please provide names and dates of other schools (high school(s), vocational schools) you have attended.
How long have you lived at your current address? If less than 5 years please list previous address(es).
* Do you have children?
* What are their names and ages?
* Do you agree to a criminal background check? Note PLOT requires a separate written background check authorization form.
* Are you employed
* How long have you been employed?
* What kind of work do you do? What are your responsibilities at work? Where do you work? What is your supervisor's name and title?
* Where did you hear about PLOT?
* Why do you want to be mentor for PLOT?
* Do you have an age preference for your mentee.
* What do you hope to get out of being a PLOT mentor?
* Do you have previous experience volunteering or mentoring? Please explain.
* Do you have experience working with youth? Please explain.
* What are your hobbies, interests or special skills? Please explain.
* Have you ever had a mentor? If so, what were the benefits and the challenges you experienced as a mentee? Please explain.
* Describe a challenge in your life and how you overcame it.
* Name three leaders whom you admire. What qualities do you admire about them?
* Please explain any leadership experience you have?
* PLOT requires mentors to commit to spending 4- 6 hours per month with their mentees for 1 year. Do you have any travel restrictions and/or scheduling concerns?
* Please provide 3 references. Mentors must provide 3 references, at least one of them professional. Please note family members cannot be references. Provide name, title, relationship, email address and phone number for each reference
Electronic Signature
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I hereby certifify that the information in this application is true.