Eye to Eye Mentor Application

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Eye to Eye

Thank you for your interest in becoming a Mentor with Eye to Eye!  

Eye to Eye is a national mentoring program that pairs middle school students with learning and attention differences (like Dyslexia and ADHD) with college and high school students who share similar labels. Our vision is to create a world in which people who learn differently are fully accepted, valued, and respected by themselves and others.

Mentors meet weekly with Mentees in a small group setting where together they complete a series of fun art-based projects from a curriculum that is proven to help students value their unique minds, build self-esteem, and develop essential social-emotional skills for success in school and life.  

Requirements
To become an Eye to Eye Mentor, you must:
  • Have one or more learning or attention difference such as ADHD, Dyslexia, Dyscalculia, Dysgraphia, or other processing, executive functioning, or language, math, or reading-based differences;
  • Be between the ages of 16 and 32 years old;
  • Be currently be enrolled as a student at a high school, college or university;
  • Complete this Mentor Application Form and Mentor Agreement;
  • Pass a criminal history background check;
  • Complete a two hour Mentor Training with a member of Eye to Eye's national staff.
Commitment
All Eye to Eye Mentors commit to:
  • Serve as a Mentor for at least one semester, preferably for one full academic year;
  • Attend all Eye to Eye weekly art rooms and events (typically 1 to 2 hours per week);
  • Adhere to all program policies and be a positive role model for young people;
  • Be dependable and notify the chapter leaders if unable to attend an art room or event;
  • Help recruit additional Mentors and Mentees to grow the Eye to Eye program.  

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Mentor Information





























Optional Questions
The following set of questions is optional, but your answers will help Eye to Eye to learn more about our program and the communities we serve.









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Parent/Guardian Information











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Mentor Agreement
I understand that Eye to Eye staff have final right to accept applicants into the program at their sole discretion, and that Eye to Eye staff reserve the right to terminate any Mentor from the program at any time for any reason. I certify that I am at least 16 years of age. I will follow all rules and guidelines as outlined by Eye to Eye staff, Mentor training, program policies, and this agreement.

I certify that I have not been convicted of any felony or misdemeanor classified as an offense against a person or family, of public indecency, or a violation involving a state or federally controlled substance. I hereby certify that I have never been accused, arrested, charged, or convicted of child abuse. I am not under current indictment. 

I give permission for Eye to Eye program staff to conduct a criminal background check and verify any and all information provided by me on this application as part of the screening for entrance into the program. I consent to the preparation of background reports by Verified Volunteer, a background check company, and to the release of such reports to Eye to Eye for the purpose of assisting Eye to Eye in making a determination as to my eligibility to be a volunteer.  I understand that, to the extent allowed by law, information contained in my application or otherwise disclosed to Eye to Eye by me before or during the volunteer period, if any, may be utilized for the purpose of obtaining such consumer reports and/or investigative consumer reports about me. I authorize law enforcement agencies, learning institutions, information service bureaus, credit bureaus, record/data repositories, courts (federal/state/local), motor vehicle record agencies, the military, and other individuals or sources to furnish any and all information on me that is requested by the consumer reporting agency. For more information about your rights under the Fair Credit Reporting Act, visit www.consumerfinance.gov/learnmore/

I understand that the program takes place solely within the scheduled sessions, exclusively at the program location, and I agree to limit my actions to the activities permitted within the confines of the program’s policies. I understand that any relationships or contact established between Mentor/Mentee and family members beyond the organized and supervised activities of the program are neither encouraged nor condoned. I understand that upon the ending of the academic year, future contact with my Mentee is beyond the scope of Eye to Eye and may happen only by the mutual consensus of the Mentor, the Mentee, a representative of the Mentee School and parent/guardian. If future contact is agreed upon, Eye to Eye will not be responsible for monitoring and supporting the match after the match has ended and Eye to Eye will not be liable for any incidences that occur after the match has closed.

Prohibited Behavior
Mentors have the ethical obligation to do no harm. This encompasses the more extreme forms of harmful behavior, such as sexual harassment, abuse and exploitation. A number of other behaviors also are not aligned with Eye to Eye's values and standards and are therefore prohibited while participants are engaged in mentoring activities or engaging with any chapter member, including Mentors, Mentees, teachers, parents, and other volunteers. Mentors understand that any violation of Eye to Eye's rules and code of ethics may be grounds for removal as a Chapter Leader or Mentor.

The following behavior is prohibited:
  • Engaging in any unwelcome and unwanted physical or verbal conduct, such as inappropriate touching, patting, pinching, punching, or assault, or the use of exploitative language in either a sexual or nonsexual nature, including threats of such behavior.
  • Physically disciplining, hitting, striking, or threatening a student  - even in so-called "play."
  • Using disrespectful language, including swearing, in the presence of students.
  • Using, possessing or being under the influence of alcohol, marijuana, or illegal drugs.
  • Smoking or use of tobacco on school grounds or in the presence of children.
  • Engaging in flirtatious behavior with a Mentee, expressing romantic feelings towards a Mentee in any form, engaging in a romantic or sexual relationship with a Mentee, stalking a Mentee, or engaging in sexual exploitation with a Mentee and any other chapter member.
  • Making unwanted sexual advances or drawing unwanted sexual attention towards other community members.
  • Use of denigrating language, public or private, directed toward any chapter member.
  • Displaying demeaning, suggestive, or pornographic material.
  • Privately giving a Mentee or his/her family money or an expensive gift or accepting money or expensive gifts from a Mentee or his/her family.
  • Meeting alone with a Mentee. All mentoring activities must be performed in a group setting. All activities will be on school grounds except for sanctioned Eye to Eye field trips.
  • Exchanging contact information and/or communicating with Mentees outside of Eye to Eye art rooms, including via private email, text, social media or live chat conversations, unless approved by the National Program Coordinator.
  • Possessing or using firearms, firecrackers, explosives, toxic or dangerous chemicals, fire, or other lethal weapons, equipment, or material while working with Mentees or participating in any Eye to Eye activity.
  • Violating any local, state, or federal law, or any safety policies of the college or high school chapter school or Mentee School.
Other Important Guidelines
  • Mentors must immediately report accidents or injuries to the Chapter Leaders. The Chapter Leaders will report the incident to a member of the Eye to Eye staff team.
  • Mentors must inform the Chapter Leader of any difficulties or areas of concern that arise in the mentoring relationship. Chapter Leaders can provide insight on how to address any challenges.
  • There may be instances when a Mentee's behavior is unacceptable. Explain to the Mentee why his/her behavior is unacceptable, but never use ultimatums. Ask for help from a Chapter Leader if you have difficulty managing your Mentee's behavior.
  • Hugs, within the group environment, are appropriate if both the giver and receiver of the hug are comfortable. Ask, "Is it okay for me to hug you?" Likewise, if you do not feel comfortable receiving a hug from a child, tell him or her this in a gentle way and suggest an alternative, such as giving a high five or putting your hand on his or her shoulder or arm.
  • If Mentors need to go to the bathroom during the art room, they should do so alone. Should a Mentee need to use the bathroom, a Mentor should escort him/her with another Mentee but wait outside of the bathroom.
  • Mentors are asked to respect the privacy of the Mentees and their families. Mentors should not discuss matters or information concerning Mentees outside the art room or with anyone other than the Chapter Leaders or National Program Coordinator.
  • Mentors must follow the dress code outlined by the Mentee School.
  • Mentors must follow Mentee School entrance and student release from school protocol.