Mentor Application
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Mentor Application
1.
First Name:
*
2.
Last Name:
*
3.
Home Address:
*
Street Address
City
State
Zip
:
4.
Home Number:
*
5.
Cell Number:
*
6.
Email:
7.
What is your employment status?
*
--Please Select--
Unemployed
Employed
Retired
Student
8.
Select any of the following that best categorizes your current or past employment.
*
Education
Technical/Sales/Administrative
Law Enforcement/Justice
Healthcare
Service
Military
Religious
Other, please specify
9.
Name of Employer:
10.
What time of the school day do you prefer to mentor?
What time of the school day do you prefer to mentor?
Morning
Afternoon
No Preference
11.
What block of time are you available?
*
12.
What day of the week do you prefer?
*
Monday
Tuesday
Wednesday
Thursday
Friday
No Preference
13.
I prefer working with students in:
*
Elementary (K-4)
Middle School (5-6)
Junior High (7-8)
High School (9-12)
PACE Center (9-12)
No Preference
14.
I prefer to mentor a:
*
--Please Select--
Girl
Boy
No Preference
15.
I prefer working with a child who is:
*
--Please Select--
Shy
Outgoing
No Preference
16.
Do you prefer mentoring at a specific school?
*
No Preference
Carleston Elementary
Challenger Elementary
Cockrell Elementary
Harris Elementary
Lawhon Elementary
Magnolia Elementary
Massey Ranch Elementary
Rustic Oak Elementary
Shadycrest Elementary
Silvercrest Elementary
Silverlake Elementary
Alexander Middle School
Jamison Middle School
Rogers Middle School
Sablatura Middle School
Berry Miller Junior High
Pearland Junior High East
Pearland Junior High South
Pearland Junior High West
PACE Center
Dawson High School
Pearland High School
Turner College & Career High School
17.
Do you speak a foreign language?
*
Do you speak a foreign language?
*
Yes
No
Language(s):
18.
How did you hear about RISE mentoring?
*
How did you hear about RISE mentoring?
*
Friend
Social Media
District Website
Other, please specify
19.
Please list two references:
*
Name
Email Address
Phone
1.
2.
20.
Please place an X by the activities you enjoy the most:
*
Playing/watching sports
Listening to music
Writing
Reading
Attending plays
Building things
Arts and Crafts
Visiting zoos and parks
Using computers
Cooking
Hiking and exploring nature
21.
In the space below, please share what other activities or hobbies not listed above you enjoy doing:
22.
To help us best match you, in the space below, please share anything you have overcome or had to deal with in your life that will help you mentor kids who may face similar struggles.
PLEASE READ CAREFULLY
Pearland ISD appreciates your interest in becoming a mentor to our students. By entering your name below, you authorize Pearland ISD to verify all information found in this application. It attests to the truthfulness of all the information listed in this application.
23.
Date:
*
24.
Applicant Name:
*