Mentor

Application

PROSPECTIVE MENTOR INFORMATION

We appreciate your interest in becoming a mentor. The information in this application will be kept confidential.

Education


Mentor Screening Information

In order to process your application, we must conduct screening procedures including a complete background check. The information listed below enables the program to complete these checks.The organization will not disclose this information to any third party not involved in conductingthese investigations.


Applicant’s Full Legal Name (required for background check)


If yes


Release of Information: I hereby grant to the OurGEMS/OurGents youth mentoring organization, and appropriate law enforcement agencies permission to check my references and civil or criminal records to verify any information provided in this application. I understand my duties as a mentor to abide by the laws of the State of Washington and the laws and policies governing the preservation of confidential information.


By signing below, you ensure to the best of your knowledge, all information provided is true and accurate.


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What's Expected of Me As A Mentor For OurGEMS/OurGents?

  1. Attend a mandatory group visitation day and a mandatory training and orientation session. This training date will be posted on our website, or you will be notified of a scheduled training time via email.
  2. Make a minimum commitment of one year with an optional opportunity to continue in the relationship on a long-term basis.
  3.  Be dedicated and dependable in trying to assist our youths in achieving success in their educational, social, and emotional development.
  4. Engage in the relationship with an open mind. Base your relationship on respect for our youths, their families, and all cultural backgrounds.
  5. Be on time for scheduled meetings. Notify the program coordinator if you are unable to attend the mentoring session.
  6. Refrain from contacting or seeing mentees outside of the established parameters and supervised sites where the program takes place except when coordinated by OurGEMS/OurGents and parent/guardian have agreed in writing to off-site meetings.
  7. Understand that while serving as a mentor for OurGEMS or OurGents, I may gain information that may be considered personal and/or confidential and should be treated accordingly. An improper disclosure to an unauthorized third partly could constitute a violation of Washington State law and make me subject to legal action. All records dealing with students/mentees must be treated as confidential.

Photo Release Statement:


By signing below, you ensure to the best of your knowledge, all information provided is true and accurate.


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OurGEMS/OurGents reserves the right to accept or decline volunteers based on the information gathered. For reasons of confidentiality OurGEMS/OurGents will not share this information or reasons of denial with any other applicants


Volunteer Mentor Status: I also understand and agree I am not an agent, employee or representative of OurGEMS/OurGents in my capacity as a mentor, nor will I claim to be such a representative, officer or employee of OurGEMS/OurGents. I will not make any claim of right, privilege or benefit that would accrue to such an agent, employee or representative. I do not expect to receive any monetary wages for services rendered during the mentoring period and understand as a volunteer I am not covered for any injury, damage or loss suffered while acting in the capacity as a mentor. I understand that if I use my private motor vehicle in the course of traveling to my volunteer mentor duties, it is my obligation to obtain and maintain state required liability insurance to cover any accidents involving my vehicle and to maintain the appropriate legally required vehicle operator’s license. I further understand that it is my responsibility to obtain and maintain insurance policies for damage, loss or liability on all personally owned, leased, or rented equipment I use while performing as a volunteer mentor. OurGEMS/OurGents will not provide any liability or other insurance coverage.


Hold Harmless: The Mentor will hold harmless OurGEMS/OurGents and its board, volunteers and employees while performing their mentoring activity, from any and all costs, claims, judgments, and/or awards of damages (both to persons and/or property), which may accrue to or be suffered by any person(s), or property, arising out of mentoring activities. The Mentor agrees to and hereby does waive any and all claims for personal injury and damages or losses to property, including expenses or lost revenues, in connection with mentoring activities. In case any claim, suit or action is brought against OurGEMS/OurGents and its board, volunteers and employees, arising out of the mentoring activity, the mentor shall, upon notice of such claim, suit or action, defend the same at their sole expense and satisfy any judgment and/or award of damages. This indemnification and waiver shall survive the termination of this release


Sign Here

If not signed, this application will not be accepted.