Mentor Application

Mentor Application Process

Complete the Mentor Application.
After completing the application, you will attend a mentor training session (lasting 2 hours.)
After your application has been received, you will be contacted so that we can set-up an interview (lasting approximately 20 minutes.)
At your interview, we will have the chance to get to know you better and answer any questions that you may have about the Program.

Mentor Responsibilities

We ask that you meet each of these responsibilities. They have been established in order to help you and your mentee have the best possible experience during your participation in the Mentor Program. It is very important for you to communicate with your mentee and B.U.I.L.D steering committee on a regular basis. We are interested in hearing how things are going, and also want to make sure you are not having any difficulties. Please let us know if there are any additional ways we can help make this a positive experience.

Attend Mentor training session (conducted by Syracuse City School District personnel) during the Fall semester (lasting 2 hours.)
Attend all C.H.O.I.C.E.S Sessions; designated B.U.I.L.D Mentor time is from 1-2 pm. Attend the Annual SES Conference)
Contact and meet with your mentee on a weekly basis for up to 3 hours; minimally 1 hour. (Please note that the 3 hour requirement is inclusive of your C.H.O.I.C.E.S session time.)
Maintain contact with the B.U.I.L.D Steering Committee members on a regular basis.
Participate in Informal Steering Committee group meetings as needed (mentors only)
If your phone number and/or address changes, notify both your mentee and the Image Initiative, Inc. as soon as possible.
If at any time you feel that you can no longer participate in the Mentoring Collective, please discuss this with us as soon as possible.

We strongly recommend that you do not participate in the program if you have any doubt about maintaining the commitment to your mentee for the minimum of an academic year (through May).

Name *

First

Last

Email Address *

Alternate Email Address

Phone Number *

Alternate Phone Number

Local Address *

Address Line 1

Address Line 2

City

State

Zip Code

Permanent Address *

Address Line 1

Address Line 2

City

State

Zip Code

Date of Birth *

Ethnicity *

Do you speak any languages other than English? *

Current Class Level: *

Expected Graduation Date: *

Major/Minor: *

Will you be employed during the current academic year?: *

If so, please note how many hours and days.

What other programs, clubs or activities will you be involved in during the current year?: *

How much time do you expect to commit to them?

Can you commit 3 hours a week to meet your mentee and participate in group activities for the rest of the academic year?: *

Do you have a car?: *

Would you like to carpool with other mentors?: *

How did you learn of the B.U.I.L.D Mentoring Collective?: *

What interests you most about being a mentor for the B.U.I.L.D Mentoring Collective?: *

Why do you want to be a mentor?

What skills would you contribute to the program?: *

How will they enhance your ability to be a mentor?

Please describe any prior experience you have had working with youth and why it would prepare you to be an effective and positive mentor. *

What are your interests and how do you enjoy spending your time?: *

Please share any additional information that would be helpful in the selection and matching process: *

Please describe your current availability: *

References

Please include name, relationship, phone number and email for each reference.

Current/previous employer, instructor, or other professional who can validate your skills and abilities: *

A person who has known you for at least two years (not a relative): *

Have you ever been convicted of a criminal act? If yes, please explain.

As a mentor, you are required to meet with your mentee for up to 3 hours a week (minimally for 1 hour) inclusive of electronic communication. In addition, you must attend the tri-weekly group activity following the C.H.O.I.C.E.S Workshop Series meetings on Saturdays (which provides designated mentoring time from 1-2 pm) and the Annual Sisters Empowering Sisters Conference as well as informal Steering Committee meetings as needed. The Steering Committee is the advisory and organizational board of the program comprised of one member from each participating organization such as the Image Initiative, Inc. Black Graduate Student Association and National Association of Negro Business and Professional Women’s Clubs, Inc.

You will be assigned a Steering Committee member who will track your progress through the tri-weekly meetings and emails. These requirements help to ensure that a one-to-one relationship can be developed between you and the mentee. Though the program is flexible we expect the above outlined from our mentors. We will do our best to match you with a mentee who we believe will make a good match for you. We will contact you for an interview after your application has been processed.

Consent and Liability Waiver

I will be participating in a variety of activities as part of my volunteer participation in the Image Initiative, Inc.’s B.U.I.L.D Mentoring Collective. I understand that my participation is voluntary. I also understand that the activity site assumes no liability for injuries or accidents beyond that which would normally be extended towards volunteers, and I assume all other liability. I understand that the Image Initiative, Inc. provides limited secondary coverage for accidental injury as a result of voluntary participation in an activity only when that activity is done directly as a part of my participation in the B.U.I.L.D Mentoring Collective program.

By submitting this form, you are verifying that the information in this application is true to your present knowledge and you agree to all conditions set forth above.