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Great Life Mentoring Volunteer Mentor Application
Full Name:
*
*Phone (Best to contact you at):
E-mail:
*
Are you 18 years of age or older?
*
Yes
No
Address (Include Zip Code):
*
How long at this address:
*
Days & Times Available:
*
Do you have your own car, valid driver's license and auto insurance?
*
Yes
No
Emergency Contact (Name, Number, Relationship):
*
Have you ever been arrested?
*
Yes
No
*If yes, please state offense:
🛈
Are you presently employed?
*
Yes
No
*Position & How Long Employed:
*Employer Name and Address:
How did you hear about Great Life?
*
Great Life Website
Volunteer Match
Poster
Online Search
Friend
Event
Other
Why do you want to be a mentor?
*
This application and any information gathered will remain the property of Great Life Mentoring. Thank you.
The following information is for research purposes only. You are not required to answer any of the following questions.
Primary Language:
English
Spanish
Russian
Other
Secondary Language:
English
Spanish
Russian
Other
Primary Religion:
Buddhist
Catholic
Christian
Hindu
Jewish
Muslim
Protestant
Other
Atheist
Sexual Orientation:
Bisexual
Gay/Lesbian
Heterosexual
Questioning
Transgender
Gender
Male
Female
Marital Status:
Single
Married
Divorced
Domestic Partnership
Separated
Widowed
Household Income:
< $10,000
$10,000 - $24,999
$25,000 - $49,999
$50,000 - $74,999
$75,000 - $99,999
$100,000 - $149,999
> $150,000
Race or Ethnic Identity:
Hispanic or Latino
Caucasian
African American
Native Hawaiian or Pacific Islander
Asian
American Indian or Alaskan Native
Other
Military Service:
Yes
No
Smoker:
Yes
No
Disabled:
Yes
No
Type of disability:
Education Level:
No Degree
H.S. Degree or GED
Some College
Associates Degree
Bachelors Degree
Masters Degree
Terminal Degree (PhD, JD, MD, etc)
Other
Degree Year:
School Name:
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