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Mentor Application

This document is an interest inventory for volunteers who wish to mentor students through the Fort Smith Public Schools mentorship program. It collects contact and preference information from potential mentors, including their name, organization, address, phone number, email, birthdate, preferred grade level to work with, and school placement preferences. It also provides a brief overview of the mentorship program's goals of building relationships between schools and the community while maintaining student confidentiality and respectful conduct.

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dawn
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26 views1 page

Mentor Application

This document is an interest inventory for volunteers who wish to mentor students through the Fort Smith Public Schools mentorship program. It collects contact and preference information from potential mentors, including their name, organization, address, phone number, email, birthdate, preferred grade level to work with, and school placement preferences. It also provides a brief overview of the mentorship program's goals of building relationships between schools and the community while maintaining student confidentiality and respectful conduct.

Uploaded by

dawn
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Mentor Information

& Interest Inventory

Volunteer Name: ____________________________________________________


Business / Organization Represented: _______________________________________
Home Address:_______________________________________________________
City: _____________________________________ State: _______ Zip:__________
Business Phone: _____________________ Mobile Number: _____________________
Email Address: ______________________________ Birthdate: ___ / ___ / ___ (m/d/y)
• Reference Name (if you are not associated with a Partner in Education): _____________________
• Reference Email/Phone Number: _________________________________________
I am a new mentor _____ I am currently mentoring at __________________________

I prefer to work with:


___ Older Elementary Students ___ Junior High Students

(Please let us know if you know where you will be mentoring.)


I plan to work with _____________________________________ School

(Please complete this if you do not know where you will be mentoring.)
I would like to be placed in close proximity to my workplace:
___ Yes, this is important ___ No, this is not important

___ I am not sure that I will be able to mentor this year, but please check in with me about the
possibility in a couple of weeks. Please ____ call ____ email

•••••

Fort Smith Public Schools volunteers build reciprocal relationships between District schools and
individuals interested in understanding and supporting the changing needs of public school
students and their teachers. The program emphasizes connecting the classroom to the
community. Volunteers who participate with the Fort Smith Public School District
acknowledge the confidentiality of student information and agree to model
respectful interaction with students and school personnel at all times.

___________________________ _____________
Signature Date

Fort Smith Public Schools, a premier district where innovation creates


excellence, is dedicated to providing an equitable, challenging educational
experience by engaging families and community partners as we prepare
students to embrace their roles in our culturally diverse community and
rapidly changing world.

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