CGM Mentoring APPLICATION

This application is to be completed by all potential mentors. It is used to help the ministry provide a safe and nurturing environment for its families and children, and to learn more about you - the potential mentor.  The following questions are very personal and for a variety of reasons may be difficult to answer.  Your responses do not automatically exclude you from being considered for a position, but will help us determine your readiness for ministry at this time and what student to pair you with.

Name *
Name
Date of Birth *
Date of Birth
Phone *
Phone
Address *
Address
If you are a student, put your school information below as appropriate
Or School Name
Or School Advisor
Employer Phone
Employer Phone
Employer Address
Employer Address
Or School Address
Please select from the drop-down menu
Please list out persons living in your house, their age, and their relationship to you
Emergency Contact Phone
Emergency Contact Phone
Have you ever been convicted of a felony or misdemeanor, other than a minor traffic violation? *
Answering "yes" do not automatically disqualify you from being a mentor
If YES, please list below all instances and briefly explain circumstances
Would you be willing to meet confidentially with a staff member to clarify any convictions? *
Please provide a brief summary of your spiritual journey. If you have come to a place of personal faith in Jesus Christ, briefly tell us about it.
References
Below we are asking for two references; one from a previous volunteering organization that you were with and the second from the church that you attend or a church that you attend. If this is your first time volunteering you may use a work reference and/or family. All information obtained by your references will remain confidential.
Volunteer Reference
Volunteer Reference
Phone for Volunteer Reference
Phone for Volunteer Reference
Pastoral/ Elder Reference
Pastoral/ Elder Reference
Phone for Pastoral/ Elder Reference
Phone for Pastoral/ Elder Reference
Mentoring Questionnaire
PLEASE READ THE FOLLOWING STATEMENT CAREFULLY BEFORE ACKNOWLEDGING THAT YOU ACCEPT THE FOLLOWING:
*
I, the undersigned, understand that the information I have provided will be verified. I hereby release and agree to hold harmless from liability any person or organization that provided information concerning me to the Common Ground Montgomery Mentoring Program. I understand that all information gathered will be kept confidential. I understand that the information collected in this form will be used to conduct a background check, and I authorize representatives of CGM to conduct state and federal background checks. I agree to strive to honor God through scripture-based teaching and conduct in the performance of any services on behalf of the Ministry and in my life.
Date *
Date