MPACT Mentor Volunteer Application

1. Interested in a Mentor position at MPACT?

Select the Mentor position that best fits your interest.

MPACT MentorMPACT Transition Mentor

MPACT Mentors are trained volunteers who, on request, provide support to parents and family members of children with disabilities throughout the special education decision-making process. Mentors may also assist in other volunteer assignments or activities. The assignments or activities may include the following.

Assignments:

Providing one-to-one parent or family assistance, resources, and/or referrals by phone, email, or in person

Preparing and supporting parents and family members to be effective participants in their child’s individualized educational plan (IEP) meetings or other educational meetings

Disseminating resource materials and specific disability information at resource fairs or community events

Providing “What is MPACT” presentations to parent support groups, organizations, and universities

Activities:

Participate in quarterly Mentor meetings online or in person

Participate in quarterly Mentor trainings online or in person

Submit required reporting documentation

Provide input for MPACT’s strategic plans

MPACT Transition Mentors are trained volunteers who specialize in the transition process from school to adult life. In addition to completing the core Mentor trainings and performing the same activities and duties as Mentors, Transition Mentors complete additional activities and duties which may include the following.

Providing one-to-one parent, family, and/or youth assistance, resources, and/or referrals by phone, email, or in person specific to the transition to adult life process

Linking parents, families, and/or youth to adult service organizations and community resources

Providing facilitation or support for the MPACT Region Transition Networks (RTN) within the Mentor’s geographical region

The following questions must be answered by those interested in becoming a Transition Mentor:

What experiences do you have in working with parents, families, and youth through the transition process to adult life?

What resources do you use specific to the transition from high school to the adult life process?

Please fill in your contact information in the space below.

First Name

Last Name

Your Position

Address

City/Town

State

Zip Code

Email Address

Phone Number

Do you have internet and computer access?

YesNo

Do you have a driver's license?

YesNo

Do you have car insurance?

YesNo

Current Employer

Employer Name

Position

City

Please explain any professional skills, special interests, hobbies, or personal experiences you believe MPACT could benefit from you sharing.

How would you describe your relationship with your child's school district?

What special education related resources do you use most often?

What are your strengths in IEP or special education services negotiations?

In which areas do you feel you need more support or training?

Experience

What is the highest level of education you have completed?

Describe all past volunteering experiences, including names of the organization/agency.

Do you belong to any groups or clubs? Please describe.

Please list any trainings related to disabilities or special education law you have attended.

Have you attended educational meetings to provide support to other parents or families? If so, how many?

2. Support

Are you a parent or family member of an individual with a disability?

YesNo

Relationship

Age

Grade

Disability

3. Referral

How did you hear about the MPACT Mentor volunteer program?

What interested you in applying for this MPACT Mentor volunteer position?

What do you hope to gain from this volunteer experience?

4. Emergency Contact

In case of an emergency, notify:

Name

Company

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

5. References

List two unrelated persons who have definite knowledge of your work ethic, your character, and any qualifications you have listed.

Reference #1

Name

Email Address

Phone Number

Years Known

Professional or Personal Reference?

Reference #2

Name

Email Address

Phone Number

Years Known

Professional or Personal Reference?