Communities In Schools of South Central Texas, Inc.
RETURNING MENTOR APPLICATION
Please Print:
Date:_________Full Legal Name: _____________________________________________
PLEASE FILL IN ANY PERSONAL INFORMATION THAT HAS CHANGED RECENTLY
Addresss:_______________________________City/State/Zip: _______________________
Home phone:(___)_____________ Cell phone: (____)____________
Email address: _____________________________________________________________
EMPLOYMENT INFORMATION: (if employed, or past employer if retired)
Employer name and adddress: _________________________________________________
__________________________________________________________________________
Work phone & extension:_______________Your Position or Title: __________________
May you be contacted at work? __________
MENTORING HISTORY:
What have you enjoyed the most about your mentoring experiences? ______________________________________________________________________________________________________________________________________________________
Please share any areas that you feel training/additional training would benefit your mentoring relationship, or ways we might improve the mentoring relationship: ______________________________________________________________________________________________________________________________________________________
ADDITIONAL VOLUNTEER OPPORTUNITIES: If you are interested in receiving information about helping with any of the following activies, please indicate:
___Wurstfest Booth (10/30-11/8/2009)
___Christmas in Gruene/Cowboy Kringle Kids Workshop (week-ends in December, 2009)
___Rock-n-Roll for Kids (Set up March 12 and/or event on March 13, 2010)
___Pack the Bus (August 6, 2010)
___Sort incoming donations to CIS Thrift Store (open 10-6 Tues.-Sat.)
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 ________ ______
Would you like to mentor the student you did last year if possible?_____ Please provide your mentee’s name:_________________________ Please provide the campus you mentored at last year:__________________
If you will be working with a new mentee this year, 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 MARION ISD
Walnut Springs Elementary Goodwin/Frazier Elementary Krueger Elementary
Memorial Elementary Bill Brown Elementary Marion High School
Klein Road Elementary Morningside Elementary
Lone Star Elementary Freiheit Elementary SCUCISD
Carl Schurz Elementary Hoffmann Lane Elementary Rose Garden Elementary
Seele Elementary Startzville Elementary Wiederstein Elementary
Oak Run Middle School Oak Creek Elementary Schertz Elementary Middle Rebecca Creek Elementary Wilder Intermediate
New Braunfels Middle Arlon Seay Elementary Rose Garden Elementary
Rebecca Creek Elementary
Churchill Middle School
Canyon Middle School
Mountain Valley Middle
THANK YOU so much for your interest in mentoring again 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.
I hereby authorize Communities In Schools of South Central Texas, Inc. to conduct a criminal background check on me as required by the CIS policies.
Signature of Applicant: _________________________ Date: ______________________
Please return by email (M’Lissa@cissouthcentraltexas.org); fax (830-620-5643);
mail (161 S. Castell Ave., New Braunfels, TX 78130) or drop off at Castell address.
