The Mentoring Institute Volunteer Application | mentoring institute home |

To become a member of The Mentoring Institute, complete the below fields and click on the "Submit" button. You will also need to attend an orientation at Volunteer Houston. Please contact Shelby Kleyn at 713-964-0236 or email us at vhemail@volunteerhouston.org for information concerning the dates of upcoming orientations. All information below will be held confidential and seen only by Volunteer Houston management.

Note: Fields marked with a • bullet are required.

•First Name:
•Last Name:
•Present Address:
•City:
•State:	Select state... AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA DC WV WI WY
•5 Digit Zip Code:
•Home Phone:
Work Phone:
Email Address:
Employer:
Occupation:
•Indicate the best way to contact you:
Work Phone      Home Phone      Email
•Age:
•Date of Birth:	(mm/dd/yyyy)
•Gender:	Male      Female

Ethnicity:

African American    American Indian    Asian

Caucasian Hispanic Other

•Education/Degrees Obtained:

High School Diploma    Undergraduate Degree

Graduate Degree Other

•Do you speak a second language?    Yes   No
  If yes, please indicate:

•Do you have previous experience as a mentor?    Yes   No
  If yes, please indicate:

•What age groups are you interested in mentoring?
   0-4      5-10      11-14      15-18      19+

•Indicate the level of mentoring that interests you most:
  One-to-one off site      One-to-one site-based      Group mentoring

•Indicate the days(s) of the week and the time(s) you are able to volunteer:

Sunday:	Morning     Afternoon     Evening
Monday:	Morning     Afternoon     Evening
Tuesday:	Morning     Afternoon     Evening
Wednesday:	Morning     Afternoon     Evening
Thursday:	Morning     Afternoon     Evening
Friday:	Morning     Afternoon     Evening
Saturday:	Morning     Afternoon     Evening

Are you willing to volunteer with individuals who may have experienced any of the following:

Sexual Abuse    Gang Involvement    Physical Disabilities    Developmental Disabilities

Physical Abuse Drug or Alcohol Abuse Juvenile Justice/Court System Chronic Illness

List any of your hobbies or interests:

•How did you hear about the Mentoring Institute?