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 experience 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 experience 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 the experience? * 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 the experience? is required.

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

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

Interests & Availability

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

What types of activities do you think you would you like to do with a mentee? Don't worry if you're not sure yet. We will provide some ideas! * The field What types of activities do you think you would you like to do with a mentee? Don't worry if you're not sure yet. We will provide some ideas! is required.

How far are you willing to travel to meet with your mentee? Please don't be shy about putting a limit on the number of miles you want to drive. This won't disqualify you, but it will help us choose the best match for you! * The field How far are you willing to travel to meet with your mentee? Please don't be shy about putting a limit on the number of miles you want to drive. This won't disqualify you, but it will help us choose the best match for you! is required.

Are you able to commit to mentoring for a period of one year? We will be supporting you every step of the way! If you foresee any possible obstacles to this year-long commitment, please select no and let's discuss! * The field Are you able to commit to mentoring for a period of one year? We will be supporting you every step of the way! If you foresee any possible obstacles to this year-long commitment, please select no and let's discuss! is required.

Over the next year, are you able to commit to meeting with your mentee: *At least once a month in-person? (More often is fine) *1-2 times each week via text/phone call to check-in? * The field Over the next year, are you able to commit to meeting with your mentee: *At least once a month in-person? (More often is fine) *1-2 times each week via text/phone call to check-in? is required.

Do you agree to submit a brief mentor update each month and to keep the mentorship program coordinator apprised of any issues or concerns about your mentee during the time you are mentoring?

All mentors are required to attend a Mentor Orientation that trains mentors on trauma and mentoring skills. Are you willing to complete this 2-hour training in-person (preferred) or online? * The field All mentors are required to attend a Mentor Orientation that trains mentors on trauma and mentoring skills. Are you willing to complete this 2-hour training in-person (preferred) or online? 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.

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, which costs $80. We are happy to cover this cost in exchange for your commitment to our mentoring program. Do you consent to a background check & fingerprint screening? * The field Mentoring requires you to submit a Level 2 Background Screening, which costs $80. We are happy to cover this cost in exchange for your commitment to our mentoring program. Do you consent to a background check & fingerprint 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.

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