Application

Thank you for your interest in becoming a Mentor through Gospel Village. Please set aside 5-8 minutes to complete our application. Once your application is complete, a mentor coordinator will review and contact you for your next steps in becoming a mentor. 

Basic Information
* First Name
* Last Name
Email Address
Contact Information
Home Address 1
Home City
Home State
Home Zip Code
Home Phone
Mobile Phone
Work phone
Preferred Method of Communication
Home Phone Cell Phone
Work Phone Email
Basic
* Date of Birth
Marital Status
Spouse First Name
Spouse Last Name
Demographic Information
* Gender
Primary Language
Other
Secondary Language
Secondary Language Other
Ethnicity
Other
Primary Religion
Other
Availability
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
1. Before School
2. AM Block
3. Lunch
4. After School
5. PM Block
Transportation
Drivers License
Drivers License State
Drivers License Number
Education
School Name
Education Level
Other
Year Degree Attained
Documents
Document Type 1 Other
Document Type 2 Other
Program Questions
How did you hear about Gospel Village?
* Occupation
* Employer
Employer Phone Number
Years or Months at Current Employer
Regular Work Hours
Auto Insurance company
Auto Insurance Expiration
* Have you ever been convicted of a DWI or DUI?
* In case of emergency who should we notify? What relation are they to you? What is their phone number?
List all the children living in your house hold, their age, and what school/grade they are in.
* Pastoral Reference: Name, Phone number, Email, Relationship
* Professional Reference: Name, Phone, Email, Relationship
* Personal Reference: Name, Phone, Email, Relationship
* Briefly describe how you are currently growing in your relationship with Jesus.
* Please provide a brief summary of your spiritual journey. If you have come to a place of personal in Jesus Christ, briefly tell us about it.
* What church are you currently attending? Are you a member? How long have you been a member?
* Regarding being a mentor: I understand the time & length commitment to becoming a mentor and will adhere to it to the best of my ability.
* Regarding being a mentor: I understand that I must attend at least one (1) Mentor Enrichment Session each year.
* Regarding being a mentor: I understand that I must respond promptly when a Gospel Village Team Member inquires how the relationship is going.
* Regarding being a mentor: I understand I must reach out to student once (1x) per week (weekly communication includes phone, email, text, or in person).
* Regarding being a mentor: I understand that I must meet with student face-to-face at least twice (2x) per month.
* ​Regarding safety: I understand the "rule of 3" and will adhere to this policy to the best of my ability in order to protect myself and my student. I will communicate with the parent/guardian on all activities planned with my student.
* Regarding our Policies: I have read, understood, and I agree to the policies/procedures listed in the mentor manual.
* Regarding our policies: I have read, understood, and agree to The Mentoring Alliance's Statement of Faith.
* If I suspect that any sexual, physical, or verbal abuse has happened or is happening to my student(s) then I will follow the guidelines in the mentor manual and contact proper authorities.
* I agree to inform Gospel Village leadership if I am convicted of a crime (misdemeanor or felony) while I am involved with Gospel Village.
Electronic Signature
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Thank you for your interest in becoming a Mentor through Gospel Village. Now that your application is complete, a mentor coordinator will review your application and contact you for your next steps in becoming a mentor.