Greater Philadelphia Mentoring Collaborative Membership Application
Are you applying as an individual or as an organization?
An Individual Application
An Organizational Application
Individual Application
First Name
Last Name
Email Address
Mobile Phone Number
Will you accept text messages from the Greater Philadelphia Mentoring Collaborative?
Yes
No
Do you have a website?
Is this your full-time job?
Yes
No
If you selected "NO" above, what is your current profession?
Have you completed all needed background checks and clearances to work with children
Criminal Background Check
Child Abuse Clearance
FBI background check (only needed if you haven't lived in PA for the last 10 years)
Do you work for an organization that provides mentorship?
Yes
No
I spend the following time managing my organization:
0-5 hours a week
6-15 hours a week
15-30 hours a week
30+ hours a week
Name of Organization
I provide direct mentoring
0-5 hours a week
6-15 hours a week
15-30 hours a week
30+ hours a week
Current Total Number of Mentees I am currently working with
Age of the Mentees I work with:
0-4
5-9
10-14
15-18
20-24
25+
Briefly Describe your Mentorship program / service model
Please list where you provide mentorship (neighborhoods / zip codes)
When do you provide mentorship (select all that apply)
Before School
In School / During School hours
After School
Summer
All year
Are you interested in starting your own organization?
Yes
No
I have all my necessary clearances to work with youth (under 18)
Yes
No
How do you define a successful Mentor/Mentee relationship?
How do you measure outcomes?
The 3 biggest issues I need help with
Getting my 501c3 / Finding a Fiscal Sponsor
Fundraising
Finding a Space
Partnering with a School
Finding Volunteers
Finding Mentees
Getting Clearances
Partnering with other Organizations
Developing my Mentorship Model
Finding my Mentees Jobs
Helping my Mentees finish high school
Helping my Mentees get into college/ secondary education /apprenticeship
Paying for or traveling to events or experiences for your Mentees
My biggest issue this year is:
What are your overall goals over the next year?
Name of Organization
Organizational Application
Organization's Name
What year was this organization founded?
This organization has established its (check all that apply)
State Incorporation
501c3 Status
Fiscal Sponsorship
Who is your fiscal sponsor?
Organization's Address
Street Address
City
State
Zip Code
Phone Number
Website
Can this phone number accept text messages?
Yes
No
Organization's Leaders's First Name
Organization's Leader's Last Name
Organization's Leader's Phone Number
Can the Organization's Leader's phone number accept texts?
Yes
No
Organization's Leader's Email
Paid Staff Size include the Organization's Leader
Number of Volunteers
My organization can provide proof that all staff and volunteers have completed the following background checks
Criminal Background
Child Abuse Clearance
FBI Background check (only needed if individual has not lived in PA for the last 10 years)
My organization provides direct mentoring
0-5 hours a week
6-15 hours a week
15-30 hours a week
30+ hours a week
My organization provides mentorship (select all that apply)
Before School
In School / During School hours
After School
Summer
All year
My organization works with Mentees ages
0-4
5-9
10-14
15-18
19-24
25+
Current Total Number of Mentees the organization is currently working with
Briefly Describe your Mentorship program / service model
Please list where you provide mentorship (neighborhoods / zip codes)
How does your organization define a successful Mentor/Mentee relationship?
How does your organization measure outcomes?
Have you completed all needed background checks and clearances to work with children
Yes
No
The 3 biggest issues my organization needs help with
Getting my 501c3 / Finding a Fiscal Sponsor
Fundraising
Finding a Space
Partnering with a School
Finding Volunteers
Finding Mentees
Getting Clearances
Partnering with other Organizations
Developing my Mentorship Model
Finding my Mentees Jobs
Helping my Mentees finish high school
Helping my Mentees get into college/ secondary education /apprenticeship
Paying for or traveling to events or experiences for your Mentees
My biggest issue this year is:
What are your overall goals over the next year?
Contact Information