Eye to Eye

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

 

Eye to Eye runs 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. This program helps us actualize our vision -- to create a world in which people who learn differently are fully accepted, valued, and respected by themselves and others.


In order to serve as an Eye to Eye Mentor, you will need to fill out the following questions. These questions help us gather the necessary information to support your school's chapter and the Mentees we serve. In alignment with all our program participants, we will be asking you to fill out a volunteer agreement form and for your commitment to support the program for the school year, approximately 14-18 art rooms.


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.


We understand this year brings a new and continued set of challenges related to the global pandemic. We commit to doing what we can to be as flexible and adaptable as possible while keeping safety and wellness as our priority.  With that being said, please check in with your Chapter Leader to confirm the Mentoring Model this year for your Chapter.

 

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 26 years old;
  • Be currently be enrolled as a student at a high school, college, or university that is apart of an Eye to Eye Chapter;
  • Complete this Mentor Application Form and Mentor Agreement;
  • Pass a criminal history background check;
  • Complete the online Mentor Training 

 

Commitment

All Eye to Eye Mentors commit to:

  • Serve as a Mentor for the first and second semester of the 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 your Chapter Leaders if unable to attend an art room or event;

  • Help recruit additional Mentors and Mentees to grow the Eye to Eye program.


Mentor Information











Please provide your mailing address for the 2021-2022 school year




Education Info





Parent/Guardian Information











Health & Wellness


Eye to Eye Experience




Background Questions
Your answers to the following questions will help Eye to Eye to learn more about our work and how to improve it.









Mentor Agreement
Standard Assumption of Risk and Release of Liability

I give my informed consent and permission to participate in Eye to Eye’s programs and related activities. I will follow all program guidelines and school-specific policies, as well as all lawful instructions by Eye to Eye volunteers and school staff members, and understand that any violation may result in my suspension and/or removal from the program.  


I release Eye to Eye of all liability of injury, death, or other damages to me, my family, estate, heirs, or assignees that may result from participation in the program, including but not limited to transportation, and hold harmless any Eye to Eye volunteer, staff member, or other representative, both collectively and individually, of any injury, physical or emotional, other than where gross negligence has been determined. 

 

I agree to allow Eye to Eye to use images and videos of me, with my first name, taken while participating in the program for Eye to Eye educational and promotional purposes.  I understand that Eye to Eye may also collect various academic, social-emotional, experience, impact, and other behavioral data to evaluate the quality of its programs by surveying its participants regularly.  I understand that participation in these surveys is completely voluntary, my individual responses will be kept confidential, and I do not have to answer any question I would rather not answer. 


By signing below, I attest to the truthfulness of all information listed on this form and agree to all the above terms and conditions. 


Additional Assumption of Risk and Release of Liability Relating to COVID-19

The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies have issued serious warnings as to the risks related to exposure to COVID-19, as well as ways that individuals and institutions can work to minimize those risks.  


At Eye to Eye, we encourage all of our students and families to follow the latest guidance provided by government agencies and experts in the scientific community when it comes to how best to minimize the risks related to COVID-19 exposure, including but not limited to:

  • Staying Home When Sick or Possibly Exposed, including if you or anyone living in your home tests positive or is in close contact with anyone who has tested positive for COVID-19 in the last 14 days, or is currently experiencing any symptoms or does not feel well.

  • Practicing Good Hygiene & Handwashing by avoiding touching your eyes, nose or mouth, covering your mouth and nose when you cough or sneeze, washing your hands frequently with soap and water for at least 20 seconds, and using hand sanitizer that is at least 60% alcohol.

  • Wearing a Mask that fully covers the mouth and nose anytime you are indoors around others.

  • Social Distancing when possible by maintaining at least 6 feet between yourself and others.

  • Getting Vaccinated when you are able to, as vaccines are free, safe, and effective.


However, even with protective policies, guidelines, and precautions in place, should you choose to participate in Eye to Eye’s program, Eye to Eye cannot guarantee that you will not become infected with COVID-19. In-person activities inherently may still result in contact between students, staff, and volunteers that can increase the risk of contracting COVID-19. 

 

By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that I may be exposed to or infected by COVID-19 by participating in in-person activities and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I may experience or incur in connection with my participation in Eye to Eye program activities. I also acknowledge that as a condition of participating in Eye to Eye’s programs and activities, I must abide by all stated Eye to Eye guidelines and school-specific policies and procedures related to COVID-19, and understand that any violation may result in my suspension and/or removal from the program.   


I hereby release, covenant not to sue, discharge, and hold harmless Eye to Eye, its employees, agents, board members, and representatives, from any and all claims, including all liabilities, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any claims based on the actions, omissions, or negligence of Eye to Eye, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any Eye to Eye program. The decision to re-engage in in-person activities is my decision, not the decision of Eye to Eye.  I further understand that this is a full and final release and waiver of all my claims for damages or injuries sustained as a result of my participation in an in-person activity and that I am voluntarily signing this knowing that I am releasing and forever discharging Eye to Eye of all liability for any losses and damages which I may sustain.


I have read and agree to adhere to the above agreement: