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--UnemployedEmployedRetiredStudent

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--GirlBoyNo Preference

15.	I prefer working with a child who is:*
	--Please Select--ShyOutgoingNo 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:*