MENTOR APPLICATION

(Applicants must be at least 18 years old)

Personal Information:

Name________________________________________________________ Gender Male Female

First Middle Last

Address (please be as specific as possible)

_________________________________________________________________________LEBANON__
Street Area of Town/City Town/City Region Country

Home phone ___________________________ Mobile phone __________________________________

Birth Date ___________________ Age _______________

E-mail address ________________________________________________________________________

If you are a student:

Which high school or university do you attend? ______________________________________________

What is your major? ___________________________________________________________________

How many more years do you need before you graduate? ______________________________________

If you are employed:

Name/address of employer/company _______________________________________________________

Work phone ___________________________ Occupation ____________________________________

Educational Background (mark one):

Some high school Graduate/professional school

High school graduate Technical school
Some college University graduate
Other (please specify) _________________________________________________________

What was your major/field of study? _______________________________________________________

Volunteer Information:

In what area would you like to mentor a youth? Check all that apply:
 Art
Music
Dance
Film
Photography
Writing
Athletics
Drama/Theatre
Other: _______________________________________________________________________

Please elaborate on the above. What specific skills can you teach a mentee? (i.e. singing, drawing,
football, etc)

Tell us a little more about how you acquired these skills (where did you learn them) and how long youve
been practicing them.

Have you been a trainer, coach, tutor, or instructor before? In what capacity?

Why do you want to become a mentor? _____________________________________________________

______________________________________________________________________________
______________________________________________________________________________

What personal skills or strengths do you have that can make you a good mentor?

_____________________________________________________________________________________
_____________________________________________________________________________________

What clubs or groups, if any, do you belong to? ______________________________________________

_____________________________________________________________________________________

What individual has served as a role model for you? Why? _____________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

What days of the week are you available to volunteer? (check all that apply):
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
What is the best time for you to volunteer? (check all that apply):
Mornings Afternoons Evenings Weekends

Please indicate your Arabic language ability: Poor

Fair
Good
Fluent
Initial the two statements below:

_____ I understand that the mentor program involves spending a minimum of one hour every week with
an assigned mentee for at least 6 months.

_____ I understand that I will be required to attend the training session and the orientation session before
becoming a mentor.

Within the past 10 years, have you been convicted of any felony or misdemeanor classified as an offense
against a person or family, or an offense of public indecency or a violation involving a controlled
substance (i.e. drugs)? YES NO

Are you under current indictment or has an attorney accepted an official complaint for any of the offenses
in question #5? YES NO

If the answer is YES to questions 5 or 6, please explain below:

_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

Additional comments:

_____________________________________________________________________________________
_____________________________________________________________________________________

Please list four references (please include at least one family member, one personal friend and one work
reference/teacher):

Name __________________________ Name __________________________

Address ________________________ Address ________________________

City ___________________________ City ___________________________

Phone number ___________________ Phone number ____________________

Email _________________________ Email ___________________________
Relationship ____________________ Relationship ______________________

Name __________________________ Name __________________________

Address ________________________ Address ________________________

City ___________________________ City ___________________________
 Phone number ___________________ Phone number ____________________
Email _________________________ Email ___________________________
Relationship ____________________ Relationship ______________________

In making this application to be a volunteer, I understand that the The VAST LINKERS has the right to
perform background checks on volunteers interested in becoming mentors. This check may be done on
me if I sign below. If I fail to sign, it may be grounds for rejecting me as a mentor.

I certify to the best of my ability that the information provided on this application is true and accurate. I
also understand that misinformation knowingly provided here, and on subsequent mentor application
forms, is grounds for dismissal.

______________________________________ _________________________________
Signature Date

Thank you for your interest in becoming a mentee with The Vast Linkers Pvt.Ltd.