Communities In Schools of South Central Texas, Inc.
MENTOR APPLICATION
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: _____
______________________________________________________________________________________________________________
MENTOR/VOLUNTEER HISTORY:
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)
| NEW BRAUNFELS ISD | COMAL ISD | SCHERTZ/CIBOLO/UCISD |
| 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: _________
Address:__________________________________________________________________
E-mail: __________________________________________________________________
Best Phone Number to reach reference:(____)___________Secondary #:( )_________
Best time to call b/w 8 and 5____________ Relationship: ___________________
2.)Name: ____________________________________________ Years known: _________
Address:__________________________________________________________________
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: kjankowski@cissouthcentraltexas.org
Our website is www.cissouthcentraltexas.org
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
