HTML Preview Youth Mentor Application page number 1.
Save Our Youth
Mentor Application
Revised –1/2007 1
NOTE: Please fax or mail completed applications to:
Attn: Jill Meyer, 303-480-1397 / 3443 W. 23
rd
Avenue Denver, CO 80211
We appreciate your interest in becoming a mentor. The information in this application will help
us to match you with an urban youth and will be kept confidential.
Date ____________________________
Name: ________________________________ Address: _______________________________
City: _________________________________________Zip: _________________________
Ethnicity: ____________________ Gender: Male/Female
Date of Birth: _________________Age: ___________
E- Mail: ______________________________________________________________________
Home Phone: _______________________________Cell Phone: ________________________
Family: Single Married Divorced Separated
Name of Spouse: _______________________Children:________________________________
How did you find out about Save Our Youth? ___church ___mentor ___website ____board/staff
other_______________
Would you agree to have us check your name through federal and state criminal records of
child abuse and neglect proceedings? (Please circle) Yes No
Social Security Number: ___________________________________ (Required for police check)
Do you have a valid Drivers License? Yes / No If yes, exp. Date ___________State ______
Do you have current vehicle insurance as required by Colorado law? Yes / No
Work Details:
Occupation: __________________________Company: _______________________________
Work Phone: _____________________________
List any special interests, skills or hobbies you have:
List examples of any prior volunteer experience:
Please circle the words that describe your personality:
Spiritual Sensitive Quiet Outgoing
Adventuresome Happy Shy Talkative
Confident Moody Nervous Friendly
Other: ________________________________________________________________________________