Mentor Interview Form

All questions must be answered!

1. How did you hear about our mentoring program?

2. How long have you known this youth, and in what way?

3. Why do you want to become a IDYCA mentor?

4. Do you sometimes have a tendency to over-commit yourself? Get too involved?

5. What special skills or talents are you willing to share?

6. Interests or Hobbies:

7. Do you currently or have you ever served as a volunteer?

8. Other current volunteer commitments:

9. What attitudes and beliefs are of special importance to you?

10. Past experience working with children/youth:

11. Do you have your own transportation?
If no, do you have access to transportation?

12. Have you ever been a victim of a crime?

13. What are some things you can think of that you might have in common with a young person?

14. How would you react if your Mentee came to you and said he/she was thinking about using drugs?

15. How would you react if your Mentee called you from jail?

16. How would you react if your Mentee told you he-she was trying to decide whether to join the Military, or take a partial scholarship and go to college?

17. Regarding your health, are there any physical limitations or special concerns?

18. Have you ever sought counseling/therapy or treatment for any reason?

19. Explain your past and present use of alcohol or any other drugs:

20. List employment for the past 5 years (beginning with the most recent).

21. How many times have you moved in the past 5 years?

22. Past residences (ONLY needed if moved outside region in last 5 years. List most recent first).

23. Have you ever been involved in, investigated for, arrested and/or convicted of a crime?

24. Do you have any final comments regarding your application to become a mentor, mentoring, your youth, or the Idaho Youth Challenge Academy?

I certify the answers provided in this interview are my answers and as such, are true and accurate.
Type Full Name for Signature:
Date:

Please provide the best day and time for our Mentor Coordinator to contact you to review these answers:

Phone Number: