New Mentor Application

Communities In Schools of South Central Texas, Inc.



Please Print:

Date: _______________________________Full Legal Name:___________________________________________________________

Address: ___________________________________________________City/State/Zip: _____________________________________

Home phone: (___)___________________________ Cell phone: (____)_______________________ DOB:___________________

Email address: ___________________________________________________________________________________________________

EDUCATIONAL BACKGROUND/ Highest level of Education (check one):

____GED____HS Grad ___ Tech Grad ____SomeCollege ____College Grad ___Post Bachelor’s

EMPLOYMENT INFORMATION:  (if employed, or past employer if retired)

Employer name and address:  _________________________________________________________________________________


Work phone & extension:________________________________Your Position or Title:  ____________________________

May you be contacted at work? __________


If you have been employed by your present employer for less than one year, please give the name and address of the company you previously worked for: _____




Have you ever been a mentor or volunteered with children? _____ If so, where?  ________________________________________________________

What did you enjoy most about your mentoring or volunteer experiences?  _____________________________________________________________


Please share why you want to be a mentor for CIS.  _____________________________________________________________________________


AVAILABILITY:  Please indicate probable days/times you’re available to mentor between 8:00 a.m. and 3:30 p.m. (especially around the lunch hour):

From              To                                           From              To

Monday         ________            ______               Thursday       _______              _______

Tuesday         ________            ______               Friday            _______              _______

Wednesday   ________            ______


Do you have any other special skills, interests, or talents that you could share with the

CIS program? (Including speaking or writing in another language. Please list language and skill level).  _________________________________________


Do you prefer to work with any specific grade levels?  Check all you could agree to work with.

_______ Elementary (Pre-K through 5th) __________Middle School (6th-8th)

________ High School (9th – 12th)


Do you prefer to work at a specific campus? _______ (If yes, circle your preferences)

Oak Run Middle School Bill Brown Elementary Clemens High School
New Braunfels Middle Clear Spring Elementary Corbett Junior High
New Braunfels High Freiheit Elementary Dobie Junior High
Goodwin/Frazier Elementary Rose Garden Elementary
Morningside Elementary Schertz Elementary
MARION ISD Rebecca Creek Elementary Steele High School
Krueger Elementary Startzville Elementary Wiederstein Elementary
Marion High School Canyon Middle School Wilder Intermediate
Church Hill Middle School
Mountain Valley Middle School

REFERENCES: (no spouses please)

1.) Name: ____________________________________________ Years known: _________


E-mail:  __________________________________________________________________

Best Phone Number to reach reference:(____)___________Secondary #:(       )_________

Best time to call b/w 8 and 5____________                   Relationship: ___________________


2.)Name: ____________________________________________ Years known: _________


E-mail: ____________________________________________________________________

Best Phone Number to reach reference:(____)___________Secondary #:(       )_________

Best time to call b/w 8 and 5____________                   Relationship: ___________________


THANK YOU for your interest in mentoring with CIS of South Central Texas, Inc.

The information you supplied will help us continue to sustain and grow the mentoring program of Communities In Schools.  We look forward to adding you to the CIS family!

Please return your application with Authorization for Criminal Background Check, and the DPS Criminal History Verification.  Thank you!!


By mail:         161 S. Castell Ave., New Braunfels, TX  78130

By fax:            830-620-5643

By email:


Our website is


ADDITIONAL VOLUNTEER OPPORTUNITIES: If you are interested in receiving information about helping with any of the following activities, please indicate:

___Wurstfest Booth (11/2 through 11/11/12)

___Rock-n-Roll for Kids (3/1 set up and/or 3/2/2012 event

___CIS thrift store, CommUnity Resale (open 10-6 Tues. thru Sat.)

___Focus on the Future After School Programs, 4-6:30pm


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