Online Mentor Application

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Online Mentor Application

Name:

Street Address:

City:

State:

Zip:

Male
Female

Driver's License:

Birth Date:

Email:

Home Phone:

Cell Phone:

Employer:

Work Phone:

1st Choice of High School:

2nd Choice of High School:

Please choose your desired role.

Advisor: Paired with 3-4 students.
Mentor: Paired with 1-2 at-risk students.

*An advisor plays the role of the “task master,” reminding students of deadlines and meetings. The mentor is a more involved role and will most likely require more time with the students.

Please choose the one of the following training times:

Tuesday, September 28, 2010 from 5:30 p.m. - 7:30 p.m.
Thursday, September 30, 2010 from 5:30 p.m. - 7:30 p.m.
Saturday, October 2, 2010 from 9:00 a.m. - 11:00 a.m.
Tuesday, October 5, 2010 from 6:00 p.m. - 8:00 p.m.

*You must attend one training session to be a knoxAchieves mentor.

Type in the case sensitive validation code.

The information I have provided is true to the best of my knowledge. I agree to allow the program to confirm all information listed and to conduct a criminal records check. I have read and understood the program’s responsibilities for assuming my role as a knoxAchieves mentor.

APPLICATIONS MUST BE SUBMITTED BY MONDAY, SEPTEMBER 13, 2010.

WE HAVE A GREAT NEED FOR MENTORS AT THE FOLLOWING SCHOOLS: AUSTIN EAST, POWELL, KARNS, CARTER, GIBBS & SOUTH DOYLE. IF YOU ARE AVAILABLE TO MENTOR AT ONE OF THESE SCHOOLS WE COULD REALLY USE YOUR HELP. THANKS!

PLEASE NOTE THAT BEARDEN, HALLS, FULTON AND WEST HIGH SCHOOLS ARE FULL! THANK YOU!

10427 Electric Avenue • Knoxville, TN 37932 • phone: 865.218.4093