USMentors Volunteer Application

^{Please complete and return by email or in person to the Office of Community Service Learning, 23 Brighton Ave., Portland, ME}

Work information:

Application Questions:

1. Have you ever been a mentor before? If so, please describe your experience.

1. Please describe your experience with community service unrelated to mentoring.

3.   Please list your favorite extra-curricular activities (from high school and college).

4.   What are you studying at USM? Thinking back to middle or high school… what were your favorite and least favorite subjects? Has this changed for you, or are your interests still the same?

5.  If you could spend a day doing whatever you wanted, how would you spend it?

6.   You will meet with your mentee at his or her school for one hour a week. What are some activities that you would like to try?

References:

Please provide the names and contact information for three people who can serve as character references for you.

Reference 1:

Name:                                                                                                  Relationship to you:                                                       

Phone:                                                                                                 Email:                                                                                   

Reference 2:

Name:                                                                                                  Relationship to you:                                                       

Phone:                                                                                                 Email:                                                                                   

Reference 3:

Name:                                                                                                  Relationship to you:                                                       

Phone:                                                                                                 Email:                                                                                   

Background information (this information will remain confidential):

1.            Have you ever been charged with or convicted of a crime other than a minor traffic offense?

If yes, please elaborate with date and offense (this may not preclude you from becoming a mentor. We will discuss this during the in-person interview):

2.            Have you ever gone by another name? If yes, please list.

3.            Accepting a long-term volunteer position in the public school system requires a background check. Please provide your driver’s license number (including state of issuance):

Refusal to provide authorization for reference and/or criminal records checks and/or providing false or misleading information on this application form shall constitute sufficient reason to deny approval to serve as a volunteer or termination as a volunteer in the Portland Public Schools.

I understand that the Portland Public Schools performs reference and criminal records checks on volunteers.  I further authorize those persons, agencies, or entities that the Portland Public Schools contact in connection with my volunteer application to fully provide the Portland Public Schools any information on the matters set forth above.  I expressly waive in connection with any request for or provision of such information, any claims, including without limitation, defamation, emotional distress, invasion of privacy, or interference with contractual relations that I otherwise might have against the Portland Public Schools, its agents, and its officials, or against any provider of such information.  I understand that the Portland Public Schools reserves the discretion to deny my application or revoke approval to serve as a volunteer at any time if it is deemed in the best interests of the district. 

Please sign:

Print name:                                                                                                                        Date:

4.            While finding a younger student with whom to match you, is there anything in particular that you would like us to keep in mind? Any considerations of background, past experience, extracurricular or academic interests?           

5.            Will you be able to commit to meeting your mentee once a week for approximately an hour?

6.            This mentoring program matches USM students with mentees at King Middle School and at Portland High School. Do you have a site preference? If you prefer to be matched with a high school student, which grade levels most interest you? Please keep in mind that a junior or senior in high school will be looking at applying to college.

7.            Matches that meet at King Middle School will meet on Monday or Tuesday afternoons, between 2:30 and 3:45. At Portland High School, their schedule is a little more flexible. What is the best meeting time for you this semester?

Program expectations:

1.            I will meet with my mentee once a week for an hour, at his or her school.

2.            If for whatever reason, I am unable to make a scheduled meeting, I will notify my mentee’s school  and the Mentoring Coordinator at USM by noon that day.

3.            I will treat my mentee with respect and compassion, and will maintain reasonable expectations that he or she interact with me in the same way.

4.            I understand that as a critical part of this mentoring program, I will be expected to attend periodic training sessions as provided by the Office of Community Service Learning.

5.            I will meet with the Mentoring Coordinator in the Office of Community Service Learning once  a month in order to brief him or her on the progress or status of my mentoring experience.

6.            During initial training, I will have received information on avenues of reporting should I encounter a crisis unfolding in the life of my mentee, or in our mentoring relationship.  I promise to follow these protocols to the best of my abilities.

7.            I will not contact him or her (nor allow myself to be contacted) through social networking sites such as MySpace, Facebook, Twitter or YouTube.

8.            I will keep an open mind and be willing to try new activities with my mentee, and I will encourage him or her to do the same!          

By signing below, I acknowledge that I have read the above program expectations, and that I will do my best to comply with them.

Signature:                                                                                                                                                                                          

Printed Name:                                                                                                                    Date:                                           

If you have any questions concerning these expectations, now or at any point in the future, please contact the Mentoring Coordinator in the Office of Community Service Learning:

Phone: 207 780 4679

Office hours: Monday through Friday, 9-5