Education:

Elementary School
Middle School
High School
College

Occupation/School:

Religious Affiliation:

Are you currently or have you been a mentor of any other organizations in the past? Yes  No

What experiences have you had with mentoring and volunteering with youth?



Why do you think you would be a good mentor?



Please list specific skills, interest and areas of knowledge that would be of use to you as a mentor or might benefit the local community in some way.



Briefly Describe Your Hobbies and Interests.



How would you describe yourself? Please check all that applies

Talkative
Quiet
Energetic
Laid Back
Funny
Serious

What do you like to do in your free time?



Please indicate your preference

Male Youth
Female Youth
Laid Back
Funny
Serious

What is the best day and time for you to volunteer as a mentor?



Reference (someone not related to you)

Are you willing to submit to a CORI Check?   Yes  No

Please list the names and addresses of three non-family references

Name 1:    Phone:

Address:

Name 2:    Phone:

Address:

Name 3:    Phone:

Address:

Thank you for taking the time to complete this profile form. This information will help to ensure that your mentoring experience with GBNCC/HERC will be mutually beneficial.