Mentor Application

Contact Information

First Name *

Last Name *

Email *

Date of Birth *

Address Line 1 *

Address Line 2

Phone *

City *

State *

Zip *

Personal Information

Preferred method of communication? * The field Preferred method of communication? is required.

How did you hear about our mentorship program? * The field How did you hear about our mentorship program? is required.

If you selected community partner, local business, or other, please specify. The maximum length for the field If you selected community partner, local business, or other, please specify. is 500 characters.

Highest Level of Education Completed: (education experience) * The field Highest Level of Education Completed: (education experience) is required.

What is your current occupation? If retired, what was your prior occupation? * The field What is your current occupation? If retired, what was your prior occupation? is required.

If you selected "Other Industry," please specify what your current or previous profession is: The maximum length for the field If you selected "Other Industry," please specify what your current or previous profession is: is 500 characters.

Do you have any experience working with teens and young adults? If so, how will it help you in working with your mentee? * The field Do you have any experience working with teens and young adults? If so, how will it help you in working with your mentee? is required.

What obstacles have you overcome/experiences have you had in life that would help you relate to this population and nurture a healthy relationship? * The field What obstacles have you overcome/experiences have you had in life that would help you relate to this population and nurture a healthy relationship? is required.

Mentoring is a big responsibility and can change the lives of both the mentor and the mentee. What do you hope to gain from the experience and what do you hope the mentee gains from the relationship? * The field Mentoring is a big responsibility and can change the lives of both the mentor and the mentee. What do you hope to gain from the experience and what do you hope the mentee gains from the relationship? is required.

What are your preferred pronouns? * The field What are your preferred pronouns? is required.

Interests & Availability

What hobbies/interests do you have? * The field What hobbies/interests do you have? is required.

What types of activities would you like to do with a mentee? * The field What types of activities would you like to do with a mentee? is required.

How far are you willing to travel to meet with your mentee? * The field How far are you willing to travel to meet with your mentee? is required.

Are you able to commit to reaching out to your mentee a minimum of 1-2 times per week via text/phone call/in person? * The field Are you able to commit to reaching out to your mentee a minimum of 1-2 times per week via text/phone call/in person? is required.

Are you able to commit to meeting your mentee a minimum of 1-2 times per month in person? * The field Are you able to commit to meeting your mentee a minimum of 1-2 times per month in person? is required.

All mentors are required to attend an initial Mentor Orientation that trains mentors on trauma and mentor skills. Are you willing to complete this 2-hour training in-person/online? * The field All mentors are required to attend an initial Mentor Orientation that trains mentors on trauma and mentor skills. Are you willing to complete this 2-hour training in-person/online? is required.

Affiliations

WAYS for Life is a non-religious, multi-cultural, all-inclusive nonprofit organization. We do not identify with any religious affiliaitaions, and we serve individuals of all cultural backgrounds and members of the LBGTQ+ community. We are a safe space.

Are you comfortable working with an individual who is affiliated with a different religion than you? * The field Are you comfortable working with an individual who is affiliated with a different religion than you? is required.

How comfortable are you working with an individual who identifies as LGBTQ+? (1- very uncomfortable; 2- slightly uncomfortable; 3- slightly comfortable; 4- very comfortable) * The field How comfortable are you working with an individual who identifies as LGBTQ+? (1- very uncomfortable; 2- slightly uncomfortable; 3- slightly comfortable; 4- very comfortable) is required.

Are there any other affiliations you would like to share? The maximum length for the field Are there any other affiliations you would like to share? is 500 characters.

Background Check Information

Mentoring requires you to submit a Level 2 Background Screening. The cost of the screening is $80. If this is required, I agree to cover the cost of this screening: * The field Mentoring requires you to submit a Level 2 Background Screening. The cost of the screening is $80. If this is required, I agree to cover the cost of this screening: is required.

Application Agreement

As a volunteer for WAYS for Life, f/k/a Ready for Life Brevard Inc., (WAYS), I agree to maintain the confidentiality of all information gained through contact with youth, other volunteers, staff, and agency information, except as stated below. As a volunteer for WAYS, I consider personal information to be confidential. I will protect the privacy of that information in accordance with the Federal and State privacy laws as well as our agency WAYS policies. This information is to be used only in activities directly related to the Agency.

WAYS does not cover injury to anyone who may be transported by volunteers. Volunteers who choose to transport WAYS. Clients, Volunteers or others in their personal vehicle assume total responsibility for these passengers; it is recommended that volunteers check with their personal automobile insurance carrier to check on the limits of their coverage. Volunteers must confirm that their mentees have a signed transportation waiver submitted at WAYS.

I agree that I further understand that I am required to report to WAYS and/or the Department of Children and Families any episode of suspected abuse, which I may discern through contacts with youth. I understand such reports are kept confidential.

As a volunteer with WAYS, I understand that I report to WAYS and agree to follow the appointed communication chain of command for any of my volunteer activities. WAYS staff are available per WAYS emergency protocol, for emergencies and will respond directly to such communications.

I will immediately report to the Executive Director or an assigned WAYS staff member any information WAYS should know.

Do you agree to the application terms? * The field Do you agree to the application terms? is required.

Volunteer Release and Waiver of Liability Form

This Release and Waiver of Liability releases WAYS for Life (WAYS) a nonprofit corporation organized and existing under the laws of the State of Florida, and each of its directors, officers, employees, and agents, from any and all liability in connection with Volunteer’s involvement with WAYS.

Volunteer desires to provide volunteer services for WAYS and engage in activities related to serving as a volunteer. Volunteer understands that the scope of Volunteer’s relationship with WAYS is limited to a volunteer position and that no compensation is expected in return for services provided by Volunteer; that WAYS will not provide any benefits traditionally associated with employment to Volunteer; and that Volunteer is responsible for his/her own insurance coverage in the event of personal injury or illness as a result of Volunteer’s services to WAYS.

1. Waiver and Release: I, the Volunteer, release and forever discharge and hold harmless WAYS and its successors and assigns from any and all liability, claims, and demands of whatever kind of nature, either in law or in equity, which arise or may hereafter arise from the services I provide to WAYS. I understand and acknowledge that this Release discharges WAYS from any liability or claim that I may have against WAYS with respect to bodily injury, personal injury, illness, death, or property damage that may result from the services I provide to WAYS or occurring while I am providing volunteer services.

2. Insurance: Further I understand that WAYS does not assume any responsibility for or obligation to provide me with financial or other assistance, including but not limited to medical, health, or disability benefits or insurance. I expressly waive any such claim for compensation or liability on the part of WAYS beyond what may be offered freely by WAYS in the event of injury or medical expenses incurred by me.

3. Medical Treatment: I hereby Release and forever discharge WAYS from any claim whatsoever which arises or may hereafter arise on account of any first-aid treatment or other medical services rendered in connection with an emergency during my tenure as a volunteer with WAYS.

4. Assumption of Risk: I understand that the services I provide to WAYS may include activities that may be hazardous to me including, but not limited to involving inherently dangerous activities. As a volunteer, I hereby expressly assume risk of injury or harm from these activities and Release WAYS from all liability.

5. Photographic Release: I grant and convey to WAYS all right, title, and interests in any and all photographs, images, video, or audio recordings of me or my likeness or voice made by WAYS in connection with my providing volunteer services to WAYS.

6. Other: As a volunteer, I expressly agree that this Release is intended to be as broad and inclusive as permitted by the laws of the State of Florida and that this Release shall be governed by and interpreted in accordance with the laws of the State of Florida. I agree that if any clause or provision of this Release is deemed invalid, the enforceability of the remaining provisions of this Release shall not be affected. By signing below, I express my understanding and intent to enter this Release and Waiver of Liability willingly and voluntarily.

Do you agree to the release & liability terms? * The field Do you agree to the release & liability terms? is required.

I agree to send the Privacy Policy Acknowledgment Form attached below kali.massa@waysforlife.org * The field I agree to send the Privacy Policy Acknowledgment Form attached below kali.massa@waysforlife.org is required.

I agree to send the Background Screening Request Form attached below kali.massa@waysforlife.org * The field I agree to send the Background Screening Request Form attached below kali.massa@waysforlife.org is required.

By digitally signing below, I agree to and accept all terms above. Please sign and date below: * The field By digitally signing below, I agree to and accept all terms above. Please sign and date below: is required.

Documents

WAYS Background Request Form.jpg

WAYS PrivacyPolicy Background Check Signiture (1).pdf