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.

Do you have any experience working with teens or young adults? If so, please describe how you believe that experience will apply to being a mentor. * The field Do you have any experience working with teens or young adults? If so, please describe how you believe that experience will apply to being a mentor. is required.

Have you had experiences / obstacles that you have overcome in your life that you feel would help you relate to youth who have experienced trauma? Feel free to give examples. * The field Have you had experiences / obstacles that you have overcome in your life that you feel would help you relate to youth who have experienced trauma? Feel free to give examples. is required.

Mentoring is a big responsibility and can positively impact the lives of both the mentor and the mentee. What do you personally hope to gain from the experience? What do you hope the mentee gains from their experience working with you? * The field Mentoring is a big responsibility and can positively impact the lives of both the mentor and the mentee. What do you personally hope to gain from the experience? What do you hope the mentee gains from their experience working with you? is required.

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

Please provide 2 character references (non-family) that our mentorship coordinator can contact to learn more about you! Please list name, relationship, length of time you have known them, their email and phone number. * The field Please provide 2 character references (non-family) that our mentorship coordinator can contact to learn more about you! Please list name, relationship, length of time you have known them, their email and phone number. is required.

Interests & Availability

What are your hobbies/interests? The more you share here, the better we can match you with a mentee that may have similar interests. * The field What are your hobbies/interests? The more you share here, the better we can match you with a mentee that may have similar interests. is required.

What activities would you enjoy doing with your mentee? If you're not sure yet, that's okay—we'll provide plenty of ideas and resources! * The field What activities would you enjoy doing with your mentee? If you're not sure yet, that's okay—we'll provide plenty of ideas and resources! is required.

How far are you willing to travel to meet your mentee? Please specify the maximum distance you're comfortable driving. This won't affect your acceptance—it simply helps us make the best match. * The field How far are you willing to travel to meet your mentee? Please specify the maximum distance you're comfortable driving. This won't affect your acceptance—it simply helps us make the best match. is required.

Can you commit to mentoring for one year? If you anticipate any challenges with this commitment, please select "No" and tell us more. We're happy to discuss any concerns with you. * The field Can you commit to mentoring for one year? If you anticipate any challenges with this commitment, please select "No" and tell us more. We're happy to discuss any concerns with you. is required.

Can you commit to meeting with your mentee in person at least once a month and checking in by phone or text 1–2 times each week over the next 12 months? * The field Can you commit to meeting with your mentee in person at least once a month and checking in by phone or text 1–2 times each week over the next 12 months? is required.

Do you agree to submit a brief monthly mentor update and promptly notify the Mentor Coordinator of any concerns or issues involving your mentee or mentoring relationship?

Mentors must complete a 6-hour training (typically 2 hours/week for 3 weeks). Can you commit to attending? If not or you're unsure, please explain what may limit your participation. * The field Mentors must complete a 6-hour training (typically 2 hours/week for 3 weeks). Can you commit to attending? If not or you're unsure, please explain what may limit your participation. is required.

What expectations do you have of your mentee? What expectations do you have of the mentor experience / our mentor program? The maximum length for the field What expectations do you have of your mentee? What expectations do you have of the mentor experience / our mentor program? is 5000 characters.

Mentor Matching

WAYS for Life is a non-religious, inclusive organization committed to providing a safe, welcoming environment for people of all backgrounds, cultures, faiths, identities, and life experiences.

Because meaningful mentoring relationships are built on trust and connection, some mentees have preferences about a mentor's background, identity, language, or lived experiences. The following questions are optional and are used only to help us make thoughtful mentor matches.

In the questions below, please share anything you believe may help us connect you with a mentee who would benefit from your unique experiences, perspectives, or interests.

To help us make the best mentor match, please check any that apply. I am comfortable mentoring...

To help us make the best mentor match, please check any that apply (optional):

If there are any aspects of your background, identity, culture, language, faith, or lived experiences that you would like us to know more about, please share here. The maximum length for the field If there are any aspects of your background, identity, culture, language, faith, or lived experiences that you would like us to know more about, please share here. is 5000 characters.

Is there anything else you'd like to share that you believe could help us make a meaningful mentor match? Examples: Languages you speak, faith or spiritual tradition, LGBTQ+ identity or allyship, cultural background or military service. The maximum length for the field Is there anything else you'd like to share that you believe could help us make a meaningful mentor match? Examples: Languages you speak, faith or spiritual tradition, LGBTQ+ identity or allyship, cultural background or military service. is 5000 characters.

Background Check Information

Mentors must pass a Level 2 background check and fingerprint screening (WAYS covers the $80 cost). Do you consent? If you have concerns about eligibility, please speak with the Program Coordinator before applying. * The field Mentors must pass a Level 2 background check and fingerprint screening (WAYS covers the $80 cost). Do you consent? If you have concerns about eligibility, please speak with the Program Coordinator before applying. 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 members, 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. Mentors must confirm that their mentees have a signed transportation waiver submitted at WAYS before transporting them.

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 contact with members. 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 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.

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