MENTOR APPLICATION

Mentoring with Blueprint 58 is all about mutual transformation and opportunities to learn and grow alongside our neighbors. Interested in being a mentor with us? Start here by filling out our mentor application and we will be in touch with next steps.

Name

First Name

Last Name

Email Address

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of Birth

YYYY

Highest Level of Education Completed

Please select one or more options

High School or GED

Some college

Associates

Bachelor

Masters

Other

Driver's License Number

Occupation

Employer

Business Phone

Do you have any previous experience mentoring?

Please select one or more options

Yes

If so, how many years?

Explain any experience you have working with children

Please list your interests and hobbies

Do you have any student preferences?

Ex: Extroverted, loves sports, age etc.

Why do you want to be a mentor?

Have you ever been charged with or convicted of a criminal offense, other than a traffic violation?

Are you willing to spend at least one year investing in the life of a student in our community?

Background Check Authorization

REFERENCES

Please include name and email addresses for 3 references (at least one must be your employer or supervisor)

Name

First Name

Last Name

Name

First Name

Last Name

Name

First Name

Last Name

MENTOR APPLICATION

Mentoring with Blueprint 58 is all about mutual transformation and opportunities to learn and grow alongside our neighbors. Interested in being a mentor with us? Start here by filling out our mentor application and we will be in touch with next steps.

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