Step 1

PERSONAL INFORMATION

If you have ever participated as a tnAchieves mentor, please click here to complete the mentor renewal application.

First Name

Middle Name

Last Name

Gender

Social Security Number*

Date of Birth

Address

City

State

Zip Code

Email Address

Primary Phone Number

Employer

Educational Attainment

Post-Secondary Institution Attended

Race/Ethnicity

*The information provided above will have no impact on mentor application status and is not shared outside of the organization.

*tnAchieves completes a criminal history and sex offender registry background check on all of our mentors prior to pairing them with students.

Step 2

Mentoring Information

Do you prefer which high school you are paired with?

Pair me at the high school in my county with the greatest need. You will be notified of your high school assignment in December!I would like to select my assigned high school.

County where you plan to serve as a mentor.

We will assign you to the high school in this county with the greatest need in February.

Select High School Preferences

Please select a county from the list below. Your county choice will determine which high school(s) you can select.

Your First Choice High School

If your school is not listed, please email ben@tnachieves.org!

Your Second Choice High School

If your school is not listed, please email ben@tnachieves.org!

How did you hear about tnAchieves?

Mentor Name

Mentor County

Name of Event

Name of Organization

Type

Please identify the media organization (Ex.Tennessean, Twitter, WBIR, etc.

Email Source (Ex. Chamber, Church, etc.)

Please Specify

Do you know a person or organization that would be interested in mentoring? If so, please enter their information in the fields below.

Name of Person/Org/Business

Contact Information

Agreements

MENTOR AGREEMENT

By typing my initials in the box below, I am indicating that 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 tnAchieves mentor and commit to the following: completing a mentor training, reaching out to students bi-weekly, assisting students with any college-related questions or concerns, and providing encouragement to ensure the students reach their full potential.

I acknowledge that as part of my mentorship I will be asked to attend an in-person meeting at my students' high school in either December or January. This meeting may take place either after or during the school day. tnAchieves will make every effort to have your meeting date, time and location to you with several months notice to allow you time to schedule and plan. tnAchieves will provide you the opportunity to adjust your high school preference should you be unable to attend your originally selected meeting.

I understand that by serving as a tnAchieves mentor, my mobile number and email may be shared with my assigned tnAchieves mentees. In your time as a mentor, tnAchieves commits to providing weekly updates to you and your students along with consistent support from the tnAchieves staff.

Please enter your initials below.

BACKGROUND CHECK RELEASE

Disclosure of Procurement of Consumer Report:

Please be advised that tnAchieves will obtain information about you from a Consumer Reporting Agency in order to evaluate your eligibility for the purpose of utilizing your volunteer services. Reports may include criminal & civil history information, motor vehicle records and moving violation reports, sex offender status reports, and Social Security Verification. You should carefully consider whether to authorize the procurement of a report. Please be further advised that you have the right, upon written request to tnAchieves, made in a reasonable time after receipt of this notice, to obtain a complete and accurate disclosure of the nature & scope of any such report.

I agree to conduct this transaction electronically.

Authorization for Release of Information:

I authorize tnAchieves to obtain investigative consumer reports about me at any time after receipt of this Authorization and, if my services as a volunteer are accepted, throughout my service to them. To this end, I direct and authorize, without reservation, any person or entity, including but not limited to, any corporation, company, business, law enforcement agency, administrator, city, county, state or federal agency, institution, school or university, information service bureau, employer, past or present, or insurance company to furnish, supply, and release any and all information regarding myself to ESS, Inc., 2500 Southlake Park, Birmingham, AL 35244, toll free 866-859-0143, www.es2.com, or its subcontractor or another outside organization acting on its behalf.

The term "background information" includes, but is not limited to, criminal and civil history information, motor vehicle records, moving violation reports, sex offender status information, and information related to my Social Security number. I agree that a facsimile, electronic or photgraphic copy of this Authorization shall be as valid as the original. I understand I can view ESS's Privacy Policy on its website, www.es2.com. PLEASE NOTE: tnAchieves only runs and reviews criminal history and sex offender registry data.

By typing my initials below, I authorize tnAchieves ("The End User") to obtain investigative consumer reports and consumer reports about me at any time after receipt of this Authorization and, if my services as volunteer are accepted, throughout my services to End User.

Please enter your initials below.

Electronic Signature

Consumer Disclosure: Employment Screening Services requests that tnAchieves provide documents, notices, and disclosures and that we obtain your signature. This electronic transaction is provided by tnAchieves in order to obtain your signature electronically and complete a background check.
Scope of Consent: You are agreeing to receive electronic notices and disclosures and to provide electronic signatures over the course of your relationship with tnAchieves. You are also agreeing to conduct transactions with tnAchieves electronically. tnAcheives will provide your information to Employment Screening Services (ESS) and the Tennessee Bureau of Investigation (TBI), tnAchieves' background check service providers, who will run a criminal history and sex offender registry report. You may at any point withdraw your consent by following the procedures described below. By proceeding forward and signing this document, you are agreeing that you have reviewed the consumer disclosure information and you consent to transact business using electronic communications and to utilize electronic signatures in lieu of using paper documents. You are not required to receive notices and disclosures electronically or sign documents electronically. If you prefer to do so, you may withdraw your consent at any time as described below.
Paper Copies: At the conclusion of this transaction, if you would like paper copies of documents or disclosures, please contact Ben Sterling with tnAchieves at 865-567-1140 or ben@tnachieves.org. If you wish to conduct this transaction with paper copies in lieu of electronic documents, you may close this web browser and contact Ben Sterling with tnAchieves at 865-567-1140 or ben@tnachieves.org. Please note: The decision to conduct this transaction electronically is solely between you and tnAchieves.
Withdrawal of Consent: You may withdraw your consent to an electronic signature and the completion of a background check, and to receive electronic documents, notices, and disclosures at any time. In order to withdraw consent, you must notify tnAchieves that you wish to withdraw consent and receive all future documents, notices, and disclosures in paper format.

I agree to conduct this transaction electronically.

Contact Information