Volunteer Mentor Application Form – Generations Connection

GENERATIONS CONNECTION
Learning together

Volunteer Mentor Application

Last Name______________________________________ First Name ________________________________________
Address____________________________________________________________________________________________________
Email__________________________________ Phone _____________________________________
Teacher certifications you hold: ________________________________
Preferences: (volunteers can mentor students outside their grade and subject certifications)
Grade(s): No preference K-2 __3-5 ___6-8 ___9-12 (check all that apply) Subject Area(s): __________________________________________________________
Location: ___In-person ___Virtual ___Either
Availability: ___Fall semester ___Spring Semester ___Summer (check all that apply)
What specific contributions can you make to the students enrolled in Generations Connection?

_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Law Violation:
Have you ever been convicted of a felony or misdemeanor? (Please circle one) YES NO
If yes, please explain (date, location, and nature of the act)

I hereby certify that the information presented on this form is true, accurate and complete. Any falsification, misrepresentation or omission will be sufficient cause for disqualification or dismissal.

Signature ___________________________________ Date _______________________________________________