WASHINGTON EDUCATION FOUNDATION
HOMETOWN MENTOR VOLUNTEER APPLICATION
Print or type responses:
Full Name
First Middle Initial Last
Mailing address
City State Zip
E-mail
Phone Numbers Home Work Cell
Employer Length of Employment
Job Title May we contact you at work?
Education completed:
High School Other 2-year degree in
4-year degree in Advanced degree(s) in
How was the Hometown Mentor Program brought to your attention?
What motivated you to apply to the Hometown Mentor Program?
Will you be able to meet with a student at least once a month during the school year? Yes or No
What are your hobbies, special skills, or other interests?
What do you like to do in your leisure?
What other affiliations (e.g., service or volunteer organizations) do you have?
What do you hope to gain from the mentoring experience?
What do you hope your mentee gains from the mentoring experience?
Mentors often have a particular set of experiences to share, please help us achieve the best possible match by specifying if you would like to mentor a student from a specific cultural background (if available)? Yes or No
If yes, what cultural background?
Is there a particular student you would like to mentor? Yes or No
If yes, name High School
Why?
Are you willing to have the College Success Foundation conduct a background check on you, including fingerprints? Yes or No
List three people (non family members) who can serve as character references for you.
(1) Name Relationship For years.
Mailing Address
City State Zip Phone
(2) Name Relationship For years.
Mailing Address
City State Zip Phone
(3) Name Relationship For years.
Mailing Address
City State Zip Phone
I certify that the information I have supplied is correct to the best of my knowledge. I grant permission for you to contact the references provided. I also understand and agree to the duties and requirements described in the Hometown Mentor Volunteer Duties and Requirements.
Signature Date
Please Return to:
-----------------------
Richard Lasso
Stadium High School
111 N E Street
Tacoma, WA 98403
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