BUILD Mentor Application

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Thank you for your interest in BUILD! We are very excited that you are interested in mentoring our amazing students. Please take a few minutes to complete the questions below. We will use this information to determine how your background and experience best fit our program. After we receive your application we will contact you to set up a short phone interview and request additional background information.

Contact Information

First Name

Last Name

Gender

FemaleMale

Birth Date

Please use this format: MM/DD/YYYY

Phone

Email Address

Ethnicity

Address Information

Address

City

State

Zip

References

References: Please list the names and phone #s of two people you would like to use as references who are able to speak to your ability to make this commitment and relate to and work with teenagers.

Reference #1 Name:	Reference #1 Relationship:
Reference #1 Email:	Reference #1 Phone:
Reference #2 Name:	Reference #2 Relationship:
Reference #2 Email:	Reference #2 Phone:

Background Check

Individuals with a history of criminal offense, felony or misdemeanor which include DUIs (within the last 7 years), any convicted crime against persons (violent/assault), sex offenses or convictions for youth abuse and neglect will be ineligible to volunteer as a mentor.

Have you ever been convicted of a criminal offense (felony or misdemeanor)?

If yes, state nature of the crime(s), when and where convicted, and disposition of the case.

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I hereby certify that all statements on this application are true to the best of my knowledge and belief. If selected as a mentor, I understand that any falsification of information may be considered cause for removal from the program. I voluntarily consent to allow BUILD (Businesses United in Investing, Lending and Development) or any of its employees or designees to check my references. BUILD may ask any questions considered to be relevant to a mentoring opportunity. Please initial here:

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