Application

Thank you for your interest in the Youth Success! Mentoring Program. Please complete and submit the following application. 

NOTE: When listing your availability, weekend and evening mentoring is NOT permitted.

Basic Information
* First Name
* Last Name
Email Address
Password
Confirm Password
Contact Information
Home Address 1
Home Address 2
Home City
Home State
Home Zip Code
Home Phone
Mobile Phone
Preferred Method of Communication
Home PhoneCell Phone
Work PhoneEmail
Basic
* Date of Birth
Motivational Factors
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
Referral
Recruitment Source
Program Questions
* How long have you lived in the state of Washington?
Employer
Current Occupation
If currently a student, school attending:
If currently a student, what grade?
Previous Volunteer Experience
Previous work with youth
* What do you like to do during your leisure time?
* To what service or social groups do you belong?
* Preferred Elementary School
* Emergency contact (Name and day phone)
* 1. Name of Personal Reference (non-relative)
* Email of Personal Reference
* Phone # of Personal Reference
* 2. Name of Personal Reference (non-relative)
* Email of Personal Reference
* Phone # of Personal Reference
* 3. Name of Personal Reference (non-relative)
* Email of Personal Reference
* Phone # of Personal Reference
* Have you ever been convicted of a crime?
If YES, please explain:
* Do you object to this program running a criminal background check on you?
If you have additional comments regarding your application information, please include them here.
* I understand that all Youth Success mentoring relationships take place on the school campus during school hours or at school authorized activities ONLY. Further, transportation of mentee in a mentor's personal vehicle is prohibited. (please initial)
* I agree to allow the Snoqualmie Valley Community Network to run a criminal background check on me. Further, I agree to adhere to all school policies for volunteers. (please initial)
* I understand that I am required to attend a new mentor training session prior to being matched with a student. (please initial)
* All information in this application is accurate to the best of my knowledge. If you agree, please enter your FULL NAME.